No description available.

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / The purpose of this study was the identification of science principles underlying the care of a patient with glomerulonephritis and the nephrotic syndrome and the deduction of appropriate nursing activities from these principles. The four sciences of anatomy, physiology, pathology and biochemistry were included in this study. / 2031-01-01

nÃo hà / INTRODUÃÃO: as glomerulopatias ainda sÃo uma das principais causas de insuficiÃncia renal crÃnica no mundo. à crescente o surgimento de registros de glomerulopatias em diversos paÃses, inclusive no Brasil. Os dados sobre incidÃncia e prevalÃncia das glomerulopatias no Brasil sÃo escassos. As conseqÃÃncias da lesÃo glomerular sÃo basicamente: proteinÃria, hematÃria, queda de filtraÃÃo glomerular, podendo evoluir para oligo-anÃria e hipertensÃo arterial decorrente da retenÃÃo de sÃdio. OBJETIVOS: determinar o perfil clÃnico, patolÃgico e epidemiolÃgico dos pacientes em acompanhamento no ambulatÃrio de glomerulopatias do ServiÃo de Nefrologia do Hospital Geral de Fortaleza. MÃTODOS: a populaÃÃo do estudo consistiu de pacientes portadores de doenÃa glomerular, submetidos à biÃpsia renal que foram atendidos no ambulatÃrio do serviÃo de Nefrologia do Hospital Geral de Fortaleza, CearÃ, durante o perÃodo de fevereiro de 2010 e setembro de 2011. RESULTADOS: foram incluÃdos no estudo um total de 168 pacientes. A idade mÃdia foi de 37  14 anos, variando de 14-77 anos. Desse total 84 pacientes (50%) eram do sexo feminino. Na avaliaÃÃo dos resultados das amostras biopsiadas obteve-se uma mÃdia de 20  12 glomÃrulos por amostra. Um total de 154 biÃpsias (92,2%) apresentaram um nÃmero maior ou igual a 8 glomÃrulos por amostra. SÃndrome nefrÃtica, foi a principal apresentaÃÃo clÃnica, correspondendo a um total de 113 pacientes (67,3%). As glomerulopatias mais prevalentes foram a GESF (19,6%), a LesÃo MÃnima (17,9%), a Glomerulopatia Membranosa (16,7%) e a Glomerulonefrite LÃpica (11,9%). As glomerulopatias primÃrias foram mais prevalentes, total de 124 casos (74,7%). Em relaÃÃo a resposta ao tratamento medicamentoso instituÃdo, 81 pacientes (68,6%) responderam ao tratamento.CONCLUSÃO: a GESF foi a glomerulopatia primÃria mais freqÃente e sÃndrome nefrÃtica a forma clÃnica de apresentaÃÃo mais comum na admissÃo. As amostras das biÃpsias renais colhidas foram satisfatÃrias em 92,2% dos casos. / INTRODUCTION: glomerulonephritis still are one of the main causes of Chronic Renal Failure (CRF). The number of cases is increasing, especially in Brazil. There are few data regarding the incidence and prevalence of glomerulonephritis in our country. Glomerular damage results in proteinuria, hematuria, decrease in glomerular filtration rate (GFR), oliguria, anuria and hypertension due to sodium overload. OBJECTIVES: the aim of this study is to determine the clinical, pathological and epidemiological features of the patients with glomerular diseases followed at the General Hospital of Fortaleza. METHODS: the study population consisted of patients with biopsy proven glomerular disease followed at the Nephrology Department of the General Hospital of Fortaleza, CearÃ, in the period between February 2010 and July 2011. RESULTS: a total of 168 patients were included. The mean age was 37  14 years. The mean number of glomeruli in each renal biopsy was 20  12. A total of 154 biopsies (92,2%) had at least 8 glomeruli per sample. Half of them were women, 84 patients (50%). The most common clinical presentation at admission was nephrotic syndrome, observed in 113 patients (67,3%). The most prevalent glomerulonephritis were Focal Segmental Glomerulosclerosis (FSGS) (19,6%), Minimal Change Disease (17,9%), Membranous Nephropathy (16,7%), and Lupus Nephritis (11,9%). Primary glomerulopathies were more common, 124 cases (74,7%). A total of 81 patients (68.6%) presented a good response to therapy, and 37 patients (31,4%) did not respond well to treatment. CONCLUSION: FSGS was the most frequent glomerulonephritis in the present study, and nephrotic syndrome was the most common clinical presentation at admission. Renal biopsies had an adequate sample size in 92,2%.

Abstract not available

The role of cholesterol-rich diet and of high protein supplement on the development of a glomerular lesion was studied in male guinea pigs. The possible pathogenesis of lipid-induced glomerulosclerosis was investigated. Four experiments were carried out. Four groups of guinea pigs were used in experiment I: CONT group was kept on normal guinea pig chow for 70 days; HC group was kept on 2% cholesterol diet for 70 days; HP group was kept on 50% casein diet for 70 days, and HCHP group received 2% cholesterol diet for 30 days and 2% cholesterol/50% casein diet for another 40 days. In experiment II two groups were used: CONT group and acetyl phenylhydrazine (APH)-treated group in which haemolytic anaemia was induced. In the third experiment the same dietary regimens as described in experiment I were used. In experiment IV three groups, namely CONT, HC, and HCHP, were employed. The animals in experiment IV were sacrificed after 5, 10, and 30 days. The first experiment explored the role of high cholesterol - and high cholesterol/high protein diet in the development of glomerulosclerosis. The other three experiments were designed to learn about the possible mechanism of lipid-induced glomerulosclerosis. Lipid analyses of plasma, erythrocytes and kidney tissue as well as complete blood count, erythrocyte osmotic fragility and blood cell morphology studies were performed. Kidney histology, histochemistry, immunohistochemistry, electron microscopy, morphometry, and renal and liver function tests were also carried out. De novo cholesterol synthesis was assessed by measuring HMG COA reductase activity and incorporation of tritiated water into cholesterol in the kidneys. Cholesterol-fed animals showed decreased weight gain, increased cholesterol concentration in plasma, erythrocytes, and kidney tissue. Haemolytic anaemia was documented after 70 days on this dietary regimen. Glomerular proliferation lesion was first noted at day 30 and progressed by day 70. Moderate proteinuria and haematuria were observed at day 70. Addition of protein to the high cholesterol diet led to a further decrease in weight gain. It also increased the mortality rate to 40% by day 70. The glomerular lesion, proteinuria and haematuria, and possibly haemolysis were more marked in the HCHP group. No causal relationship was found between liver function, immune complexes, haemolysis and glomerulosclerosis. Serum phosphate levels did not differ among the groups. The lipid found in the kidney of both HC and HCHP groups was mostly of plasma origin, since the kidney cholesterol de novo synthesis was suppressed in these two groups compared to the CONT group. There was a concommitant increase in the lipid content of kidney tissue and the mesangial expansion (MA/GTA) at day 30. No significant increase in the intraglomerular monocyte/macrophage was found at day 30 in the HCHP group compared to the HC group. However, a significant correlation (r=0.678, p 0.001) was found between the number of these cells and MA/GTA ratio among the four experimental groups at day 70. These data indicate that lipid deposits in kidney tissue may induce a glomerulosclerotic lesion in the absence of monocytes. However, these cells likely augment the proliferation of mesangial cells. We postulate that high protein diet could worsen the lipid-induced glomerular lesion by increasing delivery of abnormal lipoproteins to the kidney which could trigger mesangial cellular proliferation directly and indirectly by a macrophage-mediated process. / Medicine, Faculty of / Pathology and Laboratory Medicine, Department of / Graduate

Yi-Shen-Hua-Shi (YSHS) granule is a Chinese patent drug for treating chronic glomerulonephritis (CGN). It was marketed in 2009. However, up to now, there is no report about the quality and pharmacological activities of this product. In this work，we evaluated the quality and anti-CGN effects of the drug. To evaluate the quality of the granule, a qualitative and quantitative HPLC-DAD analytical method was developed. For qualitative analysis, HPLC fingerprint of ten batches of YSHS granule was established. The fingerprints were analyzed using similarity evaluation, hierarchical cluster analysis (HCA), principal components analysis (PCA) and orthogonal partial least squares discriminant analysis (OPLS-DA) based on 15 characteristic fingerprint peaks. Similarity values of 10-batche samples were all above 0.960, indicating a stable quality. Minor differences were observed among batches by HCA and PCA. For quantification analysis, contents of six constituents in the granule were simultaneously measured. To establish the chemical profile of the granule, a HPLC-Q-TOF- MS/MS method was developed. A total of 105 peaks were detected using HPLC-Q-TOF-MS/MS in the granule, of which, 99 were tentatively identified as terpenoids, flavonoids, coumarins, alkaloids, phenols and other types of compounds, and 15 were further validated with reference substances. HPLC fingerprint chromatogram establishment, quantification analysis of 6 constituents and compound identification should improve the quality control of YSHS granule. To study the pharmacological activities of the granule, we investigated its anti-CGN effects and TGFβ signaling-related mechanism of action. A CGN rat model was established by injection of cationization-bovine serum albumin (C-BSA) for five weeks. After C-BSA injection, drugs were intragastrically administered to the rats once daily for four weeks. Clinical signs were recorded daily. Urine and serum biochemical parameters were analyzed using respective kits. Protein levels were examined by Western blotting. Pathological changes of renal tissues were evaluated using HE and Masson's trichrome staining. No significant differences in body weights and clinical signs were found among normal, model and drug treatment groups. Proteinuria; albuminuria; increased urine volume; elevated creatinine, urea nitrogen, triglyceride levels and total cholesterol in serum; decreased serum total protein and albumin; as well as renal pathological damages and fibrosis were observed in CGN model rats. YSHS granule ameliorated all the abnormal behavioral and biochemical changes in the model rats. Mechanistic investigations revealed that YSHS granule down-regulated proteins levels of TGFβ1, phospho-Smad2/3 (Thr 8) and Smad4 in rat renal tissues. These findings indicate that the drug has anti-CGN effects in rats, and inhibiting TGFβ signaling contributes to the underlying mechanisms. In summary, our chemical analytical studies will help in improving the quality control of YSHS granule. Our bioactivity and mechanistic studies provide a pharmacological basis for the clinical use of the granule in treating CGN.

Thesis (PhD (Med))--Stellenbosch University, 2011. / ENGLISH ABSTRACT: Background and Objective: The most common cause of severe proteinuria/nephrotic syndrome (NS) in children worldwide is minimal change disease (MCD). This is also the pattern observed in white and Indian children in South Africa (SA). By contrast, black and mixed race/coloured children of Southern Africa in the 1960s to 1990s were shown to have a different pattern of NS. One of the main differences was the frequency of hepatitis B virus (HBV) associated glomerulonephritis, usually membranous glomerulonephritis (MGN). The objective of this project was a clinicopathological study of this subgroup of nephrotic children to document the disease further and in particular to seek correlations between pathological and clinical features including prognosis. A central focus was to document the detailed ultrastructural examination of the renal biopsies of these children and to correlate the spectrum of pathological features with demographic, clinical, laboratory and prognostic features. The hypothesis was that the clinicopathological features of HBV MGN in children differed substantially from idiopathic MGN in general (children and adults) and also from HBV MGN in adults and that HBV MGN in children should be viewed as a distinct disease. Patients and methods: The childhood (12 years and younger) patient cohort was 309 children with severe proteinuria/nephrotic syndrome who presented at Tygerberg Hospital (TBH) over a 21 year period from 1974-1995, including 67 children from Namibia. The study group was 71 children with HBV MGN who were followed up to 2005. The comparative adult group was 45 adults with MGN of whom 12 had HBV MGN and 33 idiopathic MGN. (A comparison could not be made with idiopathic MGN in childhood as this centre only had 2 such patients during the study period.) Demographic, clinical, laboratory and renal pathology data were collected, compared and correlated. Results: HBV associated MGN was the most frequent cause of NS in the Namibian subgroup, 25/67 (37%) and the third most frequent, 71/309 (23%) in the childhood cohort as a whole. The MGN group was 86% (71/83) of the total HBV childhood nephrotic cohort, by far the dominant subgroup. The average age of the 71 children with HBV MGN was 6.0 years (range 2-12 years) at presentation and boys comprised 80% of the group. Hepatitis B envelope antigen (HBeAg) was identified in the serum of 87% of children tested. Laboratory features different from idiopathic MGN included more prominent haematuria, mildly raised serum transaminases and more frequently lowered serum C3 and C4 levels. Light microscopic examination of renal biopsies showed mesangial proliferation in all patients but with minimal glomerular sclerosis and interstitial disease. On ultrastructural examination mesangial and subendothelial deposits were common and prominent as was mesangial interposition. The MGN of HBV in children therefore frequently showed mesangiocapillary glomerulonephritis (MCGN) features in addition to the subepithelial deposits of MGN. The subgroup of 23 whose renal biopsies displayed severe mesangial interposition in addition to the subepithelial deposits of MGN were termed the mixed HBV MGN-mesangiocapillary GN group. Virus like bodies and tubuloreticular inclusion bodies were both found in more than 80% of biopsies of childhood HBV MGN. HBeAg was identified in the subepithelial deposits in the glomeruli. This was the first time this feature was demonstrated in Africa. The 46 South African children with HBV MGN showed a cumulative remission rate of 25% at 2 years and 52% at 4 years. Seven of the children (10%) of the total cohort developed chronic renal failure (CRF). Age of 6 years and above at presentation and severe mesangial deposits on biopsy correlated with fewer remissions and poorer outcome. In 3 patients the interval between the diagnosis of HBV MGN and the onset of CRF was more than 19 years with the longest being 23 years. The 358 cases of childhood HBV MGN from Southern Africa constitute 37% of the reported childhood patients. Comparative data A comparison was made between the 71 children with HBV MGN, 12 adults with HBV MGN and 33 adults with idiopathic MGN. The main differences were that both HBV MGN groups included only coloured and black patients and were more predominantly male while the idiopathic MGN group included all races. In the HBV patients, haematuria was more frequent and severe, liver enzymes were frequently raised and C3 more frequently reduced than in the idiopathic cohort. Both groups of adult MGN patients had normal C4 levels while the childhood HBV MGN group had reduced C4 levels. The immune complex pattern in both of the HBV MGN adult and childhood groups on biopsy was similar with more mesangial and subendothelial deposits as well as mesangial interposition than the idiopathic group. Despite this similarity between the two HBV groups, both adult groups showed more glomerular sclerosis and interstitial disease than the childhood group. The clinical outcome of the children’s cohort was better than the other 2 groups with remission (52%) more frequent at 4 years (p< 0.01) and better renal and patient survival. Including the 83 cases from this series, at least 1243 renal biopsy proven cases of HBV MGN have been reported in the English literature; children (80%) and adults (20%). The male gender predominance in both age groups for HBV MGN is similar (children 79%; adults 84%) and significantly greater than for idiopathic MGN. Conclusions: The findings confirm that HBV MGN in children is a distinct form of GN which broadens the classical morphologic description of MGN by often including a number of mesangiocapillary GN features. The subgroup of renal biopsies with the most severe mesangiocapillary GN features was classified as the mixed HBV MGNmesangiocapillary GN group. The MGN spectrum as a whole comprised 86% of the HBV positive childhood group. HBV MGN was the most frequent association with NS/severe proteinuria in the Namibian subgroup (37%) and the third largest group (19%) in the SA children. It showed a relatively high spontaneous remission rate but at least 10% of the children developed renal failure. Age of 6 years and above at presentation and severe mesangial deposits on biopsy correlated with fewer remissions and poorer outcome. Extended follow up (more than 15 years) was required to demonstrate renal failure in some patients in the poor outcome group. Urbanisation, associated with lower HBV carrier rates, and HBV vaccination (initiated routinely in 1995 in SA), have already lead to a sharply decreasing incidence of this disease in SA. HBV MGN has been a valuable and possibly unique model of human GN and MGN in particular in that the HBeAg has been identified in both the serum and glomeruli enabling confirmation of the aetiological role of HBeAg. / AFRIKAANSE OPSOMMING: Agtergrond en Doelwit: Die algemeenste oorsaak van erge proteïenurie/nefrotiese sindroom (NS) in kinders wêreldwyd is minimale veranderingsiekte. Hierdie patroon kom ook voor in blanke- en Indiër kinders in Suid-Afrika. In teenstelling hiermee is aangetoon dat swart en kleurling/gemengde ras kinders in Suider Afrika tussen die jare 1960s tot 1990s ’n ander patroon van nefrotiese sindroom gehad het. Een van die hoof verskille was die algemene voorkoms van hepatitis B virus (HBV) geassosieerde glomerulonefritis, gewoonlik membraneuse glomerulonefritis (MGN). Die doelwit van hierdie projek was ’n klinies-patologiese studie van hierdie subgroep van nefrotiese kinders ten einde die siekte verder te beskryf en veral om korrelasies te tref tussen patologiese en kliniese kenmerke insluitende prognose. Die gedetaileerde ultrastrukturele ondersoek van die kinders se nierbiopsies en die korrelasie van die spektrum patologiese kenmerke met demografiese, kliniese, laboratorium en prognostiese kenmerke was ‘n sentrale fokusarea. Die hipotese was dat die klinies-patologiese kenmerke van HBV MGN in kinders wesenlik van idiopatiese MGN in die algemeen verskil (in kinders en volwassenes) en ook van HBV MGN in volwassenes, en dat die beeld in kinders as ’n afsonderlike siekte beskou behoort te word. Pasiënte en metodes: Die kinder kohort (12 jaar en jonger) was 309 kinders met erge proteïenurie/nefrotiese sindroom wie in Tygerberg Hospitaal (TBH) behandel was oor ‘n 21 jarige periode vanaf 1974 tot 1995, insluitende 67 kinders van Namibië. Die studiegroep was 71 kinders met HBV MGN wie waar moontlik tot 2005 opgevolg was. Die vergelykende volwasse groep was 45 volwassenes met MGN van wie 12 HBV MGN gehad het en 33 idiopatiese MGN. (’n Vergelyking met idiopatiese MGN in kinders kon nie gedoen word nie omdat hierdie sentrum net twee sulke pasiënte tydens die studietyd behandel het.) Demografiese, kliniese, laboratorium en nierpatologie inligting is versamel, vergelyk en gekorreleer. Resultate: HBV geassosieerde MGN was die algemeenste oorsaak van NS in die Namibiese subgroep, 25/67 (37%) en die derde mees algemeen, 71/309 (23%) in die kinder kohort as geheel. Die MGN groep was 86% (71/83) van die totale HBV kinder nefrotiese kohort en verreweg die oorheersende subgroep. Die gemiddelde ouderdom van die 71 kinders met HBV MGN by presentering was 6.0 jaar (reikwydte 2-12 jaar) en seuns het 80% van die groep behels. Hepatitis B omhullingsantigeen (envelope antigen- HBeAg) is aangetoon in die serum van 87% van die kinders wie daarvoor getoets is. Laboratoriumkenmerke wat van idiopatiese MGN verskil het, het ingesluit meer prominente hematurie, gering verhoogde serum transaminases en meer dikwels verlaagde serum C3 en C4 vlakke. Ligmikroskopiese ondersoek van die nierbiopsies het mesangiale proliferasie in elke pasiënt getoon, maar met minimale glomerulêre sklerose en interstisiële siekte. Met ultrastrukturele ondersoek was mesangiale en subendoteliële neerslae asook mesangiale interposisie algemeen. Die MGN van HBV in kinders het dus dikwels kenmerke van mesangiokapillêre glomerulonefritis getoon bo en behalwe die subepiteliële neerslae van MGN. Die ondergroep van 23 van wie die nierbiopsies erge mesangiale interposisie aangetoon het asook die subepiteliale neerslae van MGN is die gemengde HBV MGN-mesangiokapillêre GN groep genoem. Virustipe liggaampies en tubuloretikulêre insluitingsliggaampies is in meer as 80% van die biopsies bevestig. HBeAg was in die subepiteliële neerslae identifiseer. Dit was die eerste keer dat hierdie kenmerk in Afrika identifiseer is. Die 46 Suid-Afrikaanse kinders het ’n kumulatiewe remissie koers van 25% teen 2 jaar en van 52% teen 4 jaar getoon. Sewe van die kinders (10%) van die hele kohort het kroniese nierversaking (KNV) ontwikkel. Ouderdom van 6 jaar en meer by presentasie en erge mesangiale neerslae in ‘n biopsie het met minder remissies en ’n swakker uitkoms gekorreleer. Drie pasiënte het meer as 19 jaar na aanvanklike voordoening ooglopende KNV ontwikkel, waarvan 23 jaar die langste interval was. Die 358 gevalle van kinderjare HBV MGN van Suidelike-Afrika maak 37% uit van die gerapporteerde kinder pasiënte. Vergelykende data ’n Vergelyking is getref tussen die 71 kinders met HBV MGN, 12 volwassenes met HBV MGN en 33 volwassenes met idiopatiese MGN. Die hoof verskille was dat beide HBV groepe net kleurling en swart pasiënte ingesluit het en meer oorwegend manlik was, terwyl die idiopatiese groep alle rasse ingesluit het. In die HBV pasiënte was hematurie meer algemeen en erg, lewer ensieme meer dikwels verhoog en C3 meer dikwels verlaag as in die idiopatiese kohort. Beide groepe van volwasse MGN pasiënte het normale C4 vlakke getoon terwyl die kindergroep met HBV MGN verlaagde C4 vlakke bewys het. Die immuunkompleks patroon in biopsies van die HBV MGN volwasse en kindergroepe was soortgelyk met meer mesangiale en subendoteliële neerslae asook meer mesangiale interposisie as in die idiopatiese groep. Ten spyte van hierdie ooreenkoms tussen die twee HBV groepe, het die twee volwasse groepe meer glomerulêre sklerose en interstisiële siekte as die kindergroep vertoon. Die kliniese uitkoms van die kinderkohort was beter as die ander twee groepe met remissie (52%) wat meer algemeen was teen 4 jaar (p< 0.01) en met beter nier- en pasïent oorlewing. Ingeslote die 83 gevalle van hierdie reeks, is ten minste 1243 nierbiopsie bewysde gevalle van HBV MGN in kinders (80%) en volwassenes (20%) in die Engelse literatuur gerapporteer. Die manlike oorheersing in beide ouderdomsgroepe van HBV MGN is soortgelyk (kinders 79%; volwassenes 84%) en betekenisvol meer as vir idiopatiese MGN. Gevolgtrekkings: Die bevindinge bevestig dat HBV MGN in kinders ’n afsonderlike vorm van GN is wat die klassieke beskrywing van MGN verbreed deur die algemene insluiting van ’n aantal mesangiokapillêre GN kenmerke. Die ondergroep van nier biopsies met erge mesangiokapillêre GN kenmerke is as die gemengde HBV MGNmesangiokapillêre GN groep geklassifiseer. Die MGN spektrum in geheel het 86% van die HBV positiewe kindergroep behels. HBV MGN was die mees algemene assosiasie met NS/erge proteïenurie in die Namibiese subgroep (37%) en die derde grootse groep (19%) onder die SA kinders. Die siekte het ’n relatiewe hoë spontane remissiekoers getoon, maar ten minste 10% van die kinders het nierversaking ontwikkel. Ouderdom van 6 jaar en meer by presentasie en erge mesangiale neerslae in ‘n nierbiopsie het met minder remissies en ’n slegter uitkoms gekorreleer. Uitgebreide opvolg (meer as 15 jaar) was nodig om nierversaking in sommige van die swak uitkomsgroep aan te toon. Verstedeliking is geassosieerd met laer HBV draersyfers en hierdie faktor saam met algemene HBV inenting in die kinderjare (wat in 1995 in SA begin was), het ’n skerp daling in die voorkoms van hierdie siekte in SA teweeg gebring. HBV MGN is ’n waardevolle en moontlik unieke model van menslike GN en MGN, veral omdat die HBeAg in beide die serum en glomeruli identifiseer kon word om die etiologiese rol van HBeAg te bevestig.

published_or_final_version / Biological Sciences / Master / Master of Philosophy

Diese retrospektiv-deskriptive Analyse befasste sich mit dem Nephropathiespektrum des Universitätsklinikums Leipzig von 1983 bis 2010. Anders als in manch anderen Ländern existiert in Deutschland kein zentrales Register, welches bundesweit Daten zu Nephropathien sammelt und verwertet. Es wurden 467 Biopsien ausgewertet. Knapp 60% der Patienten waren männlich (n=278), 40% weiblich (n=186). Das mittlere Alter betrug 46 Jahre. Das Durchschnittsalter bei Männern betrug 47 Jahre, bei Frauen 45 Jahre. Insgesamt waren 293 primäre GN, 118 sekundäre GN und 17 INP vorhanden. Die häufigste Diagnose war die IgAN (17% der ges. NP), gefolgt von der RPGN (13 % der ges. NP), der HTNP (10%), der MCGN (9%) und der MGN (9%). Die IgAN war mit 28% aller prim. GN die häufigste primäre GN, gefolgt von der RPGN (21% der prim. GN), der MCGN (14%), der MGN (14%) und der FSGS (5%). Die HTNP war die häufigste sekundäre GN (38% der sek. GN), gefolgt von der Lupus-Nephritis (27%) und der DNP (15%). Die häufigste INP war die Calcineurin-Hemmer-NP (29% der INP), gefolgt von der TMA und der Sklerodermie-NP (jeweils 18%), der Oxalatkristall-NP und der Medikamententoxischen NP (jeweils 12%). Die mittlere Inzidenz der IgAN lag bei 0,8/100.000 Einwohner, der MesP bei 0,7/100.000 Einwohner, der MCGN bei 0,6/100.000 Einwohner, der MGN bei 0,5/100.000 Einwohner, der MPGN bei 0,3/100.000 Einwohner, der FSGS bei 1,0/100.000 Einwohner, der RPGN bei 0,7/100.000 Einwohner, der LNP bei 0,5/100.000 Einwohner, der HTNP bei 0,7/100.000 Einwohner und der DNP bei 0,4/100.000 Einwohner. Beim Vergleich des Zeitraums von 1983 bis 1990 mit dem von 1990 bis 2010 fiel eine Abnahme der IgAN von 29% auf 16%, eine Zunahme der FSGS von 0 auf 4% und der RPGN von 6% auf 14% auf. Auch die DNP nahm von 2% auf 4% zu. Unter den vom Pathologischen Institut des Uniklinikums Hamburg-Eppendorf befundeten Nierenbiopsien war die IgAN die häufigste NP, gefolgt von der RPGN. Dagegen war unter den vom Pathologischen Institut des Uniklinikums Erlangen befundeten Biopsien die FSGS die Häufigste, gefolgt von der RPGN. Der Erkrankungsgipfel lag bei der IgAN zwischen dem 29. und 48. Lebensjahr, bei der MCGN zwischen dem 28. und 58. Lebensjahr, bei der MGN zwischen dem 38. und 67. Lebensjahr und bei der FSGS zwischen dem 47. und 73. Lebensjahr. Die RPGN hatte ihren Erkrankungsgipfel zwischen der 4. und 6. Lebensdekade, die Lupus-Nephritis zwischen dem 22. und 40. Lebensjahr und die HTNP zwischen dem 41. und 61. Lebensjahr. Das mittlere Alter bei der DNP lag bei 57 Jahren. Insgesamt waren von 1983 bis 2010 Veränderungen im Nephropathiespektrum zu beobachten. Eine Zunahme der Inzidenz der FSGS, wie in außereuropäischen Ländern beschrieben, konnte festgestellt werden. Auch die Inzidenz der RPGN stieg über die letzten Jahre deutlich an und löste, gemeinsam mit der FSGS, die IgAN ab 2009 als die bis dahin häufigste Diagnose ab.

Diese retrospektiv-deskriptive Analyse befasste sich mit dem Nephropathiespektrum des Universitätsklinikums Leipzig von 1983 bis 2010. Anders als in manch anderen Ländern existiert in Deutschland kein zentrales Register, welches bundesweit Daten zu Nephropathien sammelt und verwertet. Es wurden 467 Biopsien ausgewertet. Knapp 60% der Patienten waren männlich (n=278), 40% weiblich (n=186). Das mittlere Alter betrug 46 Jahre. Das Durchschnittsalter bei Männern betrug 47 Jahre, bei Frauen 45 Jahre. Insgesamt waren 293 primäre GN, 118 sekundäre GN und 17 INP vorhanden. Die häufigste Diagnose war die IgAN (17% der ges. NP), gefolgt von der RPGN (13 % der ges. NP), der HTNP (10%), der MCGN (9%) und der MGN (9%). Die IgAN war mit 28% aller prim. GN die häufigste primäre GN, gefolgt von der RPGN (21% der prim. GN), der MCGN (14%), der MGN (14%) und der FSGS (5%). Die HTNP war die häufigste sekundäre GN (38% der sek. GN), gefolgt von der Lupus-Nephritis (27%) und der DNP (15%). Die häufigste INP war die Calcineurin-Hemmer-NP (29% der INP), gefolgt von der TMA und der Sklerodermie-NP (jeweils 18%), der Oxalatkristall-NP und der Medikamententoxischen NP (jeweils 12%). Die mittlere Inzidenz der IgAN lag bei 0,8/100.000 Einwohner, der MesP bei 0,7/100.000 Einwohner, der MCGN bei 0,6/100.000 Einwohner, der MGN bei 0,5/100.000 Einwohner, der MPGN bei 0,3/100.000 Einwohner, der FSGS bei 1,0/100.000 Einwohner, der RPGN bei 0,7/100.000 Einwohner, der LNP bei 0,5/100.000 Einwohner, der HTNP bei 0,7/100.000 Einwohner und der DNP bei 0,4/100.000 Einwohner. Beim Vergleich des Zeitraums von 1983 bis 1990 mit dem von 1990 bis 2010 fiel eine Abnahme der IgAN von 29% auf 16%, eine Zunahme der FSGS von 0 auf 4% und der RPGN von 6% auf 14% auf. Auch die DNP nahm von 2% auf 4% zu. Unter den vom Pathologischen Institut des Uniklinikums Hamburg-Eppendorf befundeten Nierenbiopsien war die IgAN die häufigste NP, gefolgt von der RPGN. Dagegen war unter den vom Pathologischen Institut des Uniklinikums Erlangen befundeten Biopsien die FSGS die Häufigste, gefolgt von der RPGN. Der Erkrankungsgipfel lag bei der IgAN zwischen dem 29. und 48. Lebensjahr, bei der MCGN zwischen dem 28. und 58. Lebensjahr, bei der MGN zwischen dem 38. und 67. Lebensjahr und bei der FSGS zwischen dem 47. und 73. Lebensjahr. Die RPGN hatte ihren Erkrankungsgipfel zwischen der 4. und 6. Lebensdekade, die Lupus-Nephritis zwischen dem 22. und 40. Lebensjahr und die HTNP zwischen dem 41. und 61. Lebensjahr. Das mittlere Alter bei der DNP lag bei 57 Jahren. Insgesamt waren von 1983 bis 2010 Veränderungen im Nephropathiespektrum zu beobachten. Eine Zunahme der Inzidenz der FSGS, wie in außereuropäischen Ländern beschrieben, konnte festgestellt werden. Auch die Inzidenz der RPGN stieg über die letzten Jahre deutlich an und löste, gemeinsam mit der FSGS, die IgAN ab 2009 als die bis dahin häufigste Diagnose ab.