The spectrum of glomerular diseases in a single center: A clinicopathological correlation

We report the spectrum of biopsy-proven glomerular disease (GD) in a single center in Eastern India. Medical records of 666 patients with biopsy-proven GD over a period of 2 years from July 2010 to July 2012 were retrospectively analyzed. The clinical, laboratory, and histological data were recorded. All biopsy specimens were examined by the same pathologist with light and immunofluorescence microscopy. Electron microscopic analysis was performed only in selected cases. Histologic spectrum of various GDs was studied along with its correlation with the clinical and laboratory parameters. The clinical diagnosis was nephrotic syndrome (NS) in 410 (61.56%), rapidly progressive renal failure/glomerulonephritis in 130 (19.52%), subnephrotic proteinuria/asymtomatic urinary abnormalities in 52 (7.81%), acute kidney injury/acute nephritic syndrome in 40 (6.01%), and macroscopic hematuria in 4 (0.6%) patients. Male: Female ratio was 1.05; 27.92% (n = 186) were < 18 years, 68.47% (n = 456) were 18-59 years, and 3.6% (n = 24) were ≥ 60 years of age. The most common GD was minimal change disease (MCD) (20.12%, n = 134); others were focal segmental glomerulosclerosis (FSGS) (18.02%, n = 15.32%), lupus nephritis (LN) (15.32%, n = 102), membranous nephropathy (MN) (12.01%, n = 80), and IgA nephropathy (IgAN) (8.11%, n = 54). Primary GD was present in 79.13% (n = 527) and common histologies were MCD (25.42%), FSGS (22.58%), MN (14.42%), and IgAN (10.25%). Secondary GD was present in 20.87% (n = 139), with the most common being LN (73.38%, n = 102). Among the NS (n = 410), the most common GD was MCD (31.46%), followed by FSGS (25.6%), MN (15.58%), LN (7.8%), IgAN (6.09%), and membranoproliferative glomerulonephritis (4.88%). FSGS was the most common primary GD in adults, MCD in children, and MN in the elderly patients. The spectrum of GD varies according to the area of study and changes over time. A biopsy registry is needed for documenting this variation.