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      Outcome of Patients with Primary Immune-Complex Type Mesangiocapillary Glomerulonephritis (MCGN) in Cape Town South Africa

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          Abstract

          Background and Aim

          Mesangiocapillary glomerulonephritis (MCGN) is a common cause of chronic kidney disease in developing countries. Data on the renal outcome of patients with idiopathic MCGN is limited. The aim of this study is to investigate the outcome of patients with idiopathic MCGN presenting to the Groote Schuur Hospital (GSH) Renal Unit in Cape Town.

          Materials and Methods

          A retrospective study of patients with idiopathic MCGN followed up at our clinic. Seventy-nine patients with no identifiable cause of MCGN were included for analysis. A composite renal outcome of persistent doubling of serum creatinine or end stage renal disease (ESRD) was used. Kaplan Meier survival and Cox regression analysis were used to assess survival and identify factors predicting the outcome.

          Results

          The mean age at biopsy was 33.9±13.6 years and 41.8% were black. Mean duration of follow up was 13.5±18.8 months. Twenty-three patients (34.2%) reached the composite endpoint. Overall, median renal survival was 38.7±11.7 months (95% CI 15.7–61.8) with 2-year and 5-year renal survival of 61% and 40.3% respectively. No significant difference was found for renal survival between males and females, treatment or non-treatment with immunosuppression, presence or absence of crescents or histological type of MCGN (p>0.05). On univariate Cox-regression analysis, factors found to be associated with the outcome were the estimated glomerular filtration rate at biopsy (OR 0.97 [95%CI: 0.95–0.99], p<0.0001), black race (OR 3.03 [95%CI: 1.27–7.21], p = 0.012) and presence of interstitial fibrosis in the biopsy (OR 2.64 [95%CI: 1.07–6.48], p = 0.034). Age, systolic blood pressure and attaining complete or partial remission approached significant values with the endpoint.

          Conclusions

          The outcome of idiopathic MCGN in Cape Town is poor and requires further prospective studies to improve our understanding of this common disease.

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          Most cited references 32

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          The timing of specialist evaluation in chronic kidney disease and mortality.

          Care for chronic renal failure involves management of complications and preparation for possible dialysis. Patients often are not evaluated by nephrologists in a timely manner. To identify factors associated with late evaluation by a nephrologist and to assess whether late evaluation is associated with worse survival once patients develop end-stage renal disease (ESRD). National prospective cohort study. 81 dialysis facilities throughout the United States. 828 patients with new-onset ESRD. Time from first evaluation by a nephrologist to initiation of dialysis, classified as late ( 12 months); rate of death, from initiation of dialysis to an average of 2.2 years of follow-up; and demographic, clinical, and laboratory characteristics. After adjustment for potential confounders, late evaluation was more common among black men than white men (44.8% vs. 24.5%; P < 0.05), uninsured patients than insured patients (56.7% vs. 29.0%; P < 0.05) and patients with severe comorbid disease than those with mild comorbid disease (35.0% vs. 23.0%; P < 0.05). Compared with patients who had early evaluation, the risk for death was greater among patients evaluated late and was graded (hazard ratio, 1.3 [95% CI, 0.87 to 2.06] for patients with intermediate evaluation and 1.8 [CI, 1.21 to 2.61] for those with late evaluation) after adjustment for dialysis method, demographic characteristics, and socioeconomic status in Cox proportional hazards regression analysis. After additional adjustment for such factors as the presence and severity of comorbid conditions, the association remained graded (hazard ratio, 1.2 [CI, 0.73 to 1.82] for patients evaluated at an intermediate point and 1.6 [CI, 1.04 to 2.39] for those evaluated late). Late evaluation of patients with chronic renal failure by a nephrologist is associated with greater burden and severity of comorbid disease, black ethnicity, lack of health insurance, and shorter duration of survival.
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            The American College of Rheumatology response criteria for proliferative and membranous renal disease in systemic lupus erythematosus clinical trials.

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              Survey of the Italian Registry of Renal Biopsies. Frequency of the renal diseases for 7 consecutive years. The Italian Group of Renal Immunopathology.

               F Schena (1997)
              This report describes data collected by the Italian Registry of Renal Biopsies (IRRB) (E mail http://www.teseo.it/nephrology/irrb), which includes 15461 renal biopsies (RB) performed over a period of 7 years (1987-1993). From 1987 to 1988, the Registry recorded only the histological diagnosis of 3686 RB, whereas beginning in 1989, additional records (sex, age, clinical symptoms and renal function) were obtained from 11,775 patients undergoing RB. This is the first report on such a large number of RB containing data from 96% of Italian renal units which routinely perform RB. In 13,835 RB performed in native kidneys, two groups of renal diseases, primary (59.9%) and secondary (25.4%) glomerulonephritis (gn), were more frequent than others. Among primary gn, the frequency of cases of IgAN, membranous gn, and focal and segmental glomerulosclerosis were 36.9, 21.7 and 10.4% respectively. Renal disease due to immune-mediated causes (51%) and dysgammaglobulinaemia (26.9%) were the most frequent among secondary gn. In the former group, the frequency of cases with lupus nephritis and vasculitis were 51.6 and 25.9% respectively. Renal amyloidosis (39.3%), essential mixed cryoglobulinaemia (30.9%), and multiple myeloma were the most frequent forms in the latter group. In 1993 the incidence of the following groups of renal disease was: primary gn (22.7 p.m.p.), secondary gn (11.1 p.m.p.) of which immune-mediated gn (5.8 p.m.p.), dysgammaglobulinaemias associated with nephritis (2.4 p.m.p.). IgAN and membranous gn, as primary gn, had an incidence of 8.4 and 4.9 p.m.p, respectively, while lupus nephritis (2.6 p.m.p.) and renal vasculitis (1.6 p.m.p.) were the most frequent forms of secondary gn. Clinical data regarding 10357 RB collected during 5 years (1989-1993), showed that the most common indications to perform RB were urinary abnormalities (30.8%) and nephrotic syndrome (27.1%), followed by recurrent episodes of macrohaematuria (8.7%) and nephritic syndrome (5.4%). Acute renal failure was present in 9.2% of patients and chronic renal insufficiency in 18.8% of cases. Membranous gn (32.9%), focal and segmental glomerulosclerosis (12.3%), and minimal-change disease (12.0%) were the most frequent diagnoses in patients with nephrotic syndrome, while post-streptococcal gn (16.1%) and IgAN (14.0%) were frequent in the nephritic syndrome. IgAN was frequently found in patients with urinary abnormalities (29.8%) and recurrent episodes of macrohematuria (71.4%). Twenty per cent of the acute renal insufficiency cases were secondary to necrotizing vasculitis, while chronic renal failure was present in 16.6% of the IgAN patients. The IRRB is considering to extend its programme to include (i) paediatric section regarding RB from patients aged less than 18 years; (ii) annual review of clinical data concerning the kidney function of selected groups of patients recorded in IRRB, and (iii) the listing of IRRB records on the INTERNET, to facilitate the distribution of information throughout the scientific community.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2014
                20 November 2014
                : 9
                : 11
                Affiliations
                [1 ]Division of Nephrology and Hypertension, Groote Schuur Hospital and University of Cape Town, South Africa
                [2 ]Division of Anatomical Pathology, National Health and Laboratory Services (NHLS), University of Cape Town, South Africa
                [3 ]Department of Medicine, Aga Khan University Hospital, Nairobi, Kenya
                Mario Negri Institute for Pharmacological Research and Azienda Ospedaliera Ospedali Riuniti di Bergamo, Italy
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: IGO TALD MD BLR GM CRS. Performed the experiments: IGO TALD MD BLR GM CRS. Analyzed the data: IGO TALD MD BLR GM CRS. Contributed reagents/materials/analysis tools: IGO TALD MD BLR GM CRS. Wrote the paper: IGO TALD MD BLR GM CRS.

                Article
                PONE-D-13-53730
                10.1371/journal.pone.0113302
                4239048
                25411791

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Pages: 10
                Funding
                The authors have no support or funding to report.
                Categories
                Research Article
                Medicine and Health Sciences
                Vascular Medicine
                Blood Pressure
                Hypertension
                Nephrology
                Chronic Kidney Disease
                Medical Dialysis
                Tubulointerstitial Disease

                Uncategorized

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