Nephrotic range proteinuria in adults: Clinicopathological experience from a single institute in rural North India

The western literature is increasingly reporting focal segmental glomerulosclerosis overtaking membranous nephropathy as the leading cause of nephrotic range proteinuria in adults. However, data from a socioeconomically and geographically diverse nation like India are limited and does not entirely align with Western observations. We undertook this study to evaluate the spectrum of glomerular diseases presenting as nephrotic range proteinuria in adults, and to establish its clinico-pathological correlation.

Ninety patients presenting with adult-onset nephrotic range proteinuria, who underwent USG-guided percutaneous renal biopsy, were evaluated clinically and histopathologically over 4 years in a tertiary care centre in north India.

The majority (28.9%) of patients were in 18-28 years age group (mean age, 39.36 years), with a 1.7:1 male-to-female ratio. The most common presenting complaint was generalised body swelling/pedal oedema (94.4%). Podocytopathy, including non-proliferative glomerulopathy suggestive of minimal change disease (26.6%) and focal segmental glomerulosclerosis (15.6%) combined, constituted the largest category (42.2%) of glomerular diseases manifesting as nephrotic range proteinuria in adult patients. Membranous nephropathy accounted for 23.33% of cases. The other etiologies included 13 (14.4%) cases of IgA nephropathy, 6 (6.6%) cases each of diabetic nephropathy and immune complex-mediated membranoproliferative glomerulonephritis, 4 (4.4%) cases of AA-type amyloidosis, and 2 (2.2%) cases of lupus nephritis.

Our study reinforces that the etiologic spectrum of adult-onset nephrotic range proteinuria in India did not entirely mirror Western trends. Podocytopathies represented the largest category, emphasising the ongoing epidemiologic transition in glomerular diseases, advocating a need for continued regional surveillance and multicenter data integration.