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Wen Y.-K.,Changhua Christian Medical Center
International Urology and Nephrology | Year: 2011

Objectives Renal biopsy has been used extensively in systemic lupus erythematosus (SLE) with renal involvement. However, there is no complete agreement about the need for renal biopsy at presentation. The goal of this study is to define the role of renal biopsy as a therapeutic guide in new-onset SLE with renal involvement. Methods We retrospectively analyzed renal biopsy findings in 131 SLE patients who received renal biopsy within 3 months from the diagnosis of SLE. Results In patients presenting with acute renal failure, 91% of patients had proliferative lupus nephritis (LN) (class IV, mixed class V ? III) and 9% had non-proliferative lupus nephropathy (pure class V). In patients presenting with nephrotic range proteinuria, proliferative LN(class III, IV, mixed classV ? III) and non-proliferative lupus nephropathy (class II, pure class V) accounted for 55% and 36% of patients, respectively, whereas 9% had non-lupus nephropathy. With the exception of anti-double-stranded DNA, no clinical findings correlated with pathology. In patients presenting with sub-nephrotic proteinuria, 49% of patients had proliferative LN(class III, IV, mixed classV ? III) and 51% had non-proliferative lupus nephropathy (class II, pure class V). Decreased C4 levels were more common in patients with proliferative LN (P = 0.031). In patients presenting with isolated hematuria, all were not active form nephropathy. Conclusions Our data suggested that similar clinical features may be observed despite very different classes of LN. Therefore, in new-onset SLE patients with clinical renal disease, early renal biopsy may be helpful in planning the treatment. © Springer Science+Business Media, B.V. 2011. Source


Wen Y.-K.,Changhua Christian Medical Center
International Urology and Nephrology | Year: 2010

Objectives: The goal of this study was to define the differences between prominent glomerular injury and prominent tubular injury in immunoglobulin (Ig) A nephropathy patients presenting with acute renal failure. Methods: In our experience of 236 patients with biopsy-proven IgA nephropathy from 2000 to 2009 at a medical center in Taiwan, 20 cases of acute renal failure were identified. The patients' records were retrospectively reviewed with respect to clinical presentation, morphology of renal biopsy, and outcomes. Results: We subdivided the 20 patients into two groups: group 1 included 9 patients with prominent glomerular injury (≥30% of glomeruli affected by crescents) and group 2 included 11 patients with prominent tubular injury (tubules filled with red blood cell casts/acute tubular necrosis/or acute interstitial nephritis). Regarding clinical parameters, the glomerular injury group had a greater urinary protein excretion (P = 0.014), a higher level of peak serum creatinine (P = 0.025), and more frequently had requirement for dialysis support (P = 0.022). Concerning histological parameters, the glomerular injury group had a higher degree of mesangial hypercellularity (P = 0.009). Regarding renal outcome, the tubular injury group had a higher remission rate than the glomerular injury group (P = 0.022). Conclusions: Histological characteristics showed two distinct mechanisms of acute kidney injury associated with IgA nephropathy, including prominent glomerular injury and prominent tubular injury. The clinical presentation and prognosis largely depended on the histological presentation. © 2009 Springer Science+Business Media, B.V. Source


Wen Y.-K.,Changhua Christian Medical Center | Chen M.-L.,Changhua Christian Medical Center
Renal Failure | Year: 2010

Background: The goal of this study was to define the clinical and histological differences in new-onset IgA nephropathy between young adults and the elderly. Methods: We retrospectively examined renal biopsy findings, clinical features at presentation and outcomes in 82 young adults (mean age 30.3 ± 10.2 years) and 17 elderly patients (mean age 71.9 ± 4.5 years) with IgA nephropathy whose renal biopsies were taken within 1 year from the onset of renal manifestations. Results: The elderly group more frequently had hypertension (p < 0.001), acute renal failure (p < 0.001), and nephrotic range proteinuria (p = 0.001) at presentation than the young adults group. On histology, a higher percentage of globally sclerotic glomeruli (p < 0.001) was present in the elderly group. In patients presenting with acute renal failure, the elderly group more frequently had an intercurrent disease (p 0.02), mostly infection, and a higher mortality rate (p 0.033). On histology, the young adults group had a higher percentage of glomeruli affected by crescents (p = 0.027); in contrast, the elderly group more commonly had acute tubular injury (p = 0.02). Conclusions: The elderly patients affected by IgA nephropathy had more severe renal manifestations at presentation (acute renal failure in 52.9 and nephrotic syndrome in 41.2 of patients). In cases of acute renal failure, the elderly patients had more predominant tubular rather than glomerular injury. Moreover, the considerable mortality rate (44.4) might be associated with the intercurrent disease, mostly infection, which was more commonly present in the elderly patients. © 2010 Informa UK, Ltd. Source


Wen Y.-K.,Changhua Christian Medical Center | Chen M.-L.,Changhua Christian Medical Center
Renal Failure | Year: 2010

Background: Acute renal failure rarely complicates the course of IgA nephropathy. In this study, we have tried to define the mode of presentation, the spectrum of morphology, and the prognostic factors for renal outcome. Methods: Twenty patients with biopsy-proven IgA nephropathy who developed acute renal failure were identified from 2000 to 2009 at a medical center in Taiwan. The patients' records were retrospectively reviewed with respect to clinical presentation, morphology of renal biopsy, and outcomes. Results: On histology, glomerular crescents were present in 11 patients (55%), acute tubular necrosis was identified in 11 patients (55%), acute interstitial nephritis was seen in 4 patients (20%), and extensive tubular red blood cell casts were present in 4 patients (20%). At the end of follow-up, 2 patients (10%) had died, 11 patients (55%) were in remission, and 7 patients (35%) developed end-stage renal disease. The prognostic factors for renal outcome were peak serum creatinine, dialysis support requirement, morphology (prominent glomerulartubular injury), percentage of glomeruli affected by crescents, and interstitial infiltration (p = 0.04, <0.001, 0.013, 0.05, 0.02, respectively). Conclusions: Our findings suggested that there were four pathogenic mechanisms involved in IgA nephropathy with acute renal failure including (1) crescentic IgA nephropathy; (2) acute tubular necrosis associated with microhematuria and red blood cell casts occluding tubules; (3) acute tubular necrosis not related to microhematuria; and (4) acute interstitial nephritis, apparently induced by drugs. In general, patients with prominent tubular injury had a much higher remission rate than patients with prominent glomerular injury. © 2010 Informa UK Ltd. Source


Wen Y.-K.,Changhua Christian Medical Center | Chen M.-L.,Changhua Christian Medical Center
Renal Failure | Year: 2010

Background: Glomerular "full-house" immunofluorescence staining commonly indicates lupus nephritis. However, some non-lupus nephropathy also can present with a "full-house" immunofluorescence pattern mimicking lupus nephritis. The goal of this study is to define the clinicopathological spectrum of originally non-lupus "full-house" nephropathy. Methods: Records of 24 patients with "full-house" nephropathy in the absence of clinical or serological evidence of systemic lupus erythematosus (SLE) at the time of renal biopsy were abstracted for demographics, clinical presentation, laboratory data, renal biopsy findings, and clinical follow-up. Results: The clinicopathological diagnoses included membranous glomerulonephritis (GN) (46%), IgA nephropathy (21%), membranoproliferative GN (12.5%), postinfectious GN (12.5%), C1q nephropathy (4%), and unclassified mesangial GN (4%). No one had endothelial tubuloreticular inclusions. One patient originally diagnosed as IgA nephropathy developed anti-DNA antibody and another one patient with membranous GN developed hypocomplementemia 8 months and 10 months after renal biopsy, respectively. The two patients also developed clinical symptoms of lupus subsequently. Conclusions: There was a broad spectrum of glomerular histological findings in non-lupus "full-house" nephropathy. The possibility of "full-house" nephropathy preceding the emergence of overt systemic lupus erythematosus remained to be elucidated. © 2010 Informa UK Ltd. Source

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