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CHAPTER 3 Secondary Glomerulonephritis

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Title: CHAPTER 3 Secondary Glomerulonephritis


1
CHAPTER 3 Secondary Glomerulonephritis
  • Rosnawati Yahya Liew Yew Foong

2
Table 3.1 Causes of secondary glomerulonephritis
in adult, 2005-2010
Hemolytic uraemic syndrome/Thrombotic
thrombocytopenic purpura
4th MRRB report 2010, Malaysia
3
Table 3.2.2.1 (a) Age group at time of biopsy
(years), 2005-2010
Year 2005 2006 2007 2008 2009 2010 Total
n 239 274 285 314 276 303 1691
Mean 30.41 30.88 29.72 30.54 29.20 30.39 30.19
Standard Deviation 10.56 10.34 10.03 11.05 9.70 10.87 10.45
Median 29.00 29.61 27.46 28.35 27.61 27.92 28.00
Interquartile range 16.01 14.61 14.84 16.40 14.15 14.12 15.18
Minimum 15.00 15.00 15.15 15.08 15.03 15.09 15.00
Maximum 70.42 59.44 67.48 65.35 62.80 78.87 78.87
4th MRRB report 2010, Malaysia
4
Figure 3.2.2.1 Age group at time of biopsy
(years), 2005-2010
4th MRRB report 2010, Malaysia
5
Figure 3.2.2.2 Gender distribution, 2005-2010
4th MRRB report 2010, Malaysia
6
Figure 3.2.2.3 Racial distribution, 2005-2010
4th MRRB report 2010, Malaysia
7
Figure 3.2.3 Clinical presentation by year,
2005-2010
4th MRRB report 2010, Malaysia
8
Figure 3.2.3 (a) Hypertension by year, 2005-2010
4th MRRB report 2010, Malaysia
9
Figure 3.2.3 (b) Impaired renal function by year,
2005-2010
4th MRRB report 2010, Malaysia
10
Table 3.2.3.1(a) Clinical presentation by age
group, 2005-2010
Age group (years) 15-lt25 15-lt25 25-lt35 25-lt35 35-lt45 35-lt45 45-lt55 45-lt55 55-lt65 55-lt65 65 65 Total Total
Age group (years) n n n n n N n
Urine abnormality 211 32.8 198 36.6 140 42.3 60 39.5 11 61.1 3 50.0 623 36.8
Nephritic syndrome 71 11.0 60 11.1 32 9.7 8 5.3 1 5.6 1 16.7 173 10.2
Nephrotic syndrome 187 29.1 170 31.4 101 30.5 37 24.3 2 11.1 1 16.7 498 29.5
Nephrotic-Nephritic 90 14.0 67 12.4 33 10.0 24 15.8 2 11.1 0 0.0 216 12.8
Not available/ Missing 84 13.1 46 8.5 25 7.6 23 15.1 2 11.1 1 16.7 181 10.7
TOTAL 643 100 541 100 331 100 152 100 18 100 6 100 1691 100
4th MRRB report 2010, Malaysia
11
Figure 3.2.3.1(a) Clinical presentation by age
group, 2005-2010
4th MRRB report 2010, Malaysia
12
Figure 3.2.3.1(b) Hypertension by age group
2005-2010
4th MRRB report 2010, Malaysia
13
Figure 3.2.3.1(c) Impaired renal function by age
group, 2005-2009
4th MRRB report 2010, Malaysia
14
Figure 3.2.3.2 (a) Clinical presentation by
gender, 2005-2010
4th MRRB report 2010, Malaysia
15
Figure 3.2.3.2(b) Hypertension by gender,
2005-2010
4th MRRB report 2010, Malaysia
16
Figure 3.2.3.2(c) Impaired renal function by
gender, 2005-2010
4th MRRB report 2010, Malaysia
17
Table 3.2.3.3 (a) Clinical presentation by
histopathology in lupus nephritis, 2005-2010
Clinical Presentations I I II II III IIIV III IIIV IV IVV IV IVV V IIV V IIV VI VI Total Total
Clinical Presentations n n n n n n n
Urine abnormality 5 45.5 68 50.7 164 45.8 287 29.8 81 45.5 7 58.3 615 36.9
Nephritic syndrome 1 9.1 16 11.9 33 9.2 111 11.5 8 4.5 0 0.0 169 10.2
Nephrotic syndrome 4 36.4 30 22.4 89 24.9 310 32.2 56 31.5 1 8.3 490 29.4
Nephroticnephritic syndrome 1 9.1 12 9.0 37 10.3 145 15.1 13 7.3 2 16.7 212 12.7
Not available/ Missing 0 0.0 8 6.0 35 9.8 109 11.3 20 11.2 2 16.7 179 10.8
Total 11 100 134 100 358 100 962 100 178 100 12 100 1665 100
26 cases are missing on lupus subclass
4th MRRB report 2010, Malaysia
18
Figure 3.2.3.3 (a) Clinical presentation by
histopathology in lupus nephritis, 2005-2010
4th MRRB report 2010, Malaysia
19
Figure 3.2.3.3(b) Hypertension by histopathology,
2005-2010
4th MRRB report 2010, Malaysia
20
Figure 3.2.3.3(c) Impaired renal function by
histopathology, 2005-2010
4th MRRB report 2010, Malaysia
21
Table 3.2.4.1 Renal function by age group in
lupus nephritis, 2005-2010
e-GFR (ml/min/1.73m2) 15-lt25 15-lt25 25-lt35 25-lt35 35-lt45 35-lt45 45-lt55 45-lt55 55-lt65 55-lt65 gt65 gt65 Total Total
e-GFR (ml/min/1.73m2) n n n n n n n
lt15 37 5.8 27 5.0 20 6.0 18 11.8 4 22.2 1 16.7 107 6.3
15 to lt 30 41 6.4 43 7.9 36 10.9 22 14.5 1 5.6 3 50.0 146 8.6
30 to lt 60 97 15.1 106 19.6 73 22.1 43 28.3 8 44.4 0 0.0 327 19.3
60 to lt 90 137 21.3 128 23.7 102 30.8 38 25.0 2 11.1 1 16.7 408 24.1
gt 90 283 44.0 201 37.2 76 23.0 26 17.1 2 11.1 1 16.7 589 34.8
Missing 48 7.5 36 6.7 24 7.3 5 3.3 1 5.6 0 0.0 114 6.7
Total 643 100 541 100 331 100 152 100 18 100 6 100 1691 100
4th MRRB report 2010, Malaysia
22
Figure 3.2.4.1 Renal function by age group in
lupus nephritis, 2005-2010
4th MRRB report 2010, Malaysia
23
Figure 3.2.4.2 Renal function at presentation by
gender, 2005-2010
4th MRRB report 2010, Malaysia
24
Table 3.2.4.3 Renal function at presentation by
histopathology, 2005-2010
26 cases are missing on lupus subclass
4th MRRB report 2010, Malaysia
25
Table 3.2.5 Histopathological diagnosis in lupus
nephritis by year, 2005-2010
26 cases are missing on lupus subclass
4th MRRB report 2010, Malaysia
26
Table 3.2.5.1 Histopathological diagnosis by age
group in lupus nephritis, 2005-2010
26 cases are missing on lupus subclass
4th MRRB report 2010, Malaysia
27
Table 3.2.5.2 Histopathological diagnosis by
gender in lupus nephritis, 2005-2010
Histopathology Male Male Female Female Total Total
Histopathology n n n
Class I 1 0.5 10 0.7 11 0.7
Class II 13 6.4 121 8.3 134 8.0
Class III and IIIV 47 23.2 311 21.3 358 21.5
Class IV and IVV 106 52.2 856 58.5 962 57.8
Class V and IIV 32 15.8 146 10.0 178 10.7
Class VI 2 1.0 10 0.7 12 0.7
Others 2 1.0 8 0.5 10 0.6
Total 203 100.0 1462 100.0 1665 100.0
26 cases are missing on lupus subclass
4th MRRB report 2010, Malaysia
28
Table 3.2.5.3 Histopathological diagnosis by
clinical presentation, 2005-2010
26 cases are missing on lupus subclass
4th MRRB report 2010, Malaysia
29
Table 3.2.6.1 ARA criteria in lupus nephritis,
2005-2010
Number of ARA criteria 2005 2005 2006 2006 2007 2007 2008 2008 2009 2009 2010 2010 Total Total
Number of ARA criteria n n n n n n n
lt4 77 32.2 90 32.8 104 36.5 128 40.8 107 38.8 125 41.3 631 37.3
4 and more 162 67.8 184 67.2 181 63.5 186 59.2 169 61.2 178 58.7 1060 62.7
Total 239 100 274 100 285 100 314 100 276 100 303 100 1691 100
4th MRRB report 2010, Malaysia
30
Figure 3.2.6.2 ARA criteria by age group,
2005-2010
4th MRRB report 2010, Malaysia
31
Figure 3.2.6.3 ARA criteria by gender, 2005-2010
4th MRRB report 2010, Malaysia
32
Figure 3.2.6.4 ARA criteria by histopathology,
2005-2010
4th MRRB report 2010, Malaysia
33
Table 3.2.6.5 (a) Extra-renal involvement by
gender, 2005-2010
Other organs involvement Male (n203) Male (n203) Female (n1488) Female (n1488) Total (n1691) Total (n1691)
Other organs involvement n n n
Mucocutaneous 95 46.8 803 54.0 898 53.1
Arthritis 40 19.7 543 36.5 583 34.5
Serositis 13 6.4 131 8.8 144 8.5
Cerebral 29 14.3 164 11.0 193 11.4
Haematological 80 39.4 596 40.1 676 40.0
Total 257 2237 2494
Patients may have 1 or more other organ
involvements
4th MRRB report 2010, Malaysia
34
Figure 3.2.6.5 (a) Extra-renal involvement by
gender, 2005-2010
4th MRRB report 2010, Malaysia
35
Table 3.2.6.5 (b) Mucocutaneous involvement by
gender in lupus nephritis, 2005-2010
Mucocutaneous involvement Male (n 95) Male (n 95) Female (n803) Female (n803) Total (n898) Total (n898)
Mucocutaneous involvement n n n
Malar rash 69 72.6 615 76.6 684 76.2
Discoid rash 22 23.2 115 14.3 137 15.3
Photosensitivity 49 51.6 384 47.8 433 48.2
Oral ulcer 40 42.1 338 42.1 378 42.1
Total 180 1452 1632
Patients may have 1 or more other organ
involvements
4th MRRB report 2010, Malaysia
36
Figure 3.2.6.5 (b) Mucocutaneous involvement by
gender in lupus nephritis, 2005-2010
4th MRRB report 2010, Malaysia
37
Table 3.2.7.1 Patients Survival estimates for
death in lupus nephritis
Interval (months) SLE patients survival SLE patients survival SLE patients survival
Interval (months) n survival SE
0 1531 100.0 -
12 1376 92.8 0.007
24 1091 89.7 0.008
36 848 87.7 0.009
48 592 85.6 0.010
60 354 83.0 0.012
72 157 81.3 0.014
Missing of 7 censored cases where the outcome
date lt date of 1st biopsy
Event death Status as at 31 Dec 2011 or last
follow-up
4th MRRB report 2010, Malaysia
38
Figure 3.2.7.1 Patients Survival estimates for
death in lupus nephritis
4th MRRB report 2010, Malaysia
39
Table 3.2.7.2 Renal Survival estimates for lupus
nephritis
Interval (months) SLE patients survival SLE patients survival SLE patients survival
Interval (months) n survival SE
0 1531 100.0 -
12 1374 98.2 0.003
24 1086 97.4 0.004
36 846 96.5 0.005
48 590 95.7 0.006
60 353 94.8 0.007
72 157 93.2 0.011
Missing of 4 censored and 3 event cases where
the outcome date lt date of 1st biopsy Event
ESRF Status as at 31 Dec 2011 or died or last
follow-up
4th MRRB report 2010, Malaysia
40
Figure 3.2.7.2 Renal Survival estimates for
lupus nephritis
4th MRRB report 2010, Malaysia
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