PATTERN OF GLOMERULAR DISEASE IN BANGLADESH- A SINGLE CENTER STUDY AT TERTIARY CARE HOSPITAL

Dr. Md. Abdullah Al Mamun*, Dr. Mohammad Mirazul Hasan, Dr. Syed Mahbub Morshed, Dr. Ratan Das Gupta, Dr. Gobinda Chandra Roy and Dr. A. H. M. Nazmul Ahsan

ABSTRACT

Introduction: Glomerular disease is a leading cause of chronic kidney disease in developing countries as well as developed countries. In Bangladesh, prevalence of CKD and ESRD increasing mostly due to glomerulonephritis. Presentation of glomerular disease ranges from asymptomatic to life threatening acute complications. The prevalence of glomerular disease is different in various regions of the world. This study reflects pattern of glomerular disease and their clinicopathological and histological characteristics in Bangladeshi population. Objective: In this study our main goal is to Identify of Clinical and Histological pattern of glomerular disease can introduce earlier treatment and prevent chronic kidney disease and ESRD. Methods: This study has been conducted at department of nephrology, Shaheed Suhrawardy Medical College hospital from January 2017 to June 2018. 206 patients of glomerular disease included in the study with proteinuria >0.5gm/day or presence of RBC or RBC cast in urine and or renal impairment. Selected patients were evaluated with history, clinical examination and laboratory investigations. After taking consent renal biopsy was performed and histopathology (light microscopy and DIF) done by expert pathologist. Data were analyzed by using SPSS software. Result: Total 206 patients included in the study with mean age 34.5±14.13 years (13-70 years), female was predominant than male (61.5%). More than 50% of participant were less than 40 years of age. Most common presentation was edema (87.2%). Others were oliguria, hematuria, shortness of breath, hypertension, anemia, arthritis, skin rash, sore throat and features of renal failure. Histologically mesangial proliferative glomerulonephritis was more common variety among all (34.3%). Others were lupus nephritis (15%), membranoproliferative (MPGN) 12.1%, FSGS (11.6%), IgA nephropathy (5.8%), MCD (5.3%), membranous nephropathy (3.9%) and IgM nephropathy (2.9%). Histological diagnosis could not be performed remaining 8.7% of patient due inadequate sample or chronic sclerosing glomerulonephritis. Proteinuria varies in different type of glomerulonephritis with mean UTP 4.24±3.17 gm/day (0.5-19.7 gm/day). Renal impairment (serum creatinine >1.4 mg/dl) was found to be 50.49% (104) cases. More than 50% of patient with mesangial proliferative, membranoproliferative glomerulonephritis, FSGS, Membranous Nephropathy, Lupus Nephritis and IgA Nephropathy had renal impairment. Conclusion: Presentation of glomerulonephritis ranges from asymptomatic to chronic kidney disease. Early histological diagnosis is essential for management of glomerular disease to prevent CKD and other complications. The result of this study may helpful for treatment of glomerulonephritis and reduce glomerulonephritis related complications as well as prevent chronic kidney disease in our country.

Keywords: Glomerular, oliguria, hematuria, chronic kidney disease.