Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2011 | Month : April | Volume : 5 | Issue : 2 | Page : 295 - 300

The Histopathological Profile Of Kidney Diseases In A Single Center In Egypt: An Overview Of 14 Years Of Experience

HAMDY AHMED SLIEM*, GAMAL AHMED TAWFIK**, MAHA ATWA*** Mohammed Mostafa

Ass. Prof. of internal medicine, faculty of medicine, Suez Canal University, Ismailia, Egypt; ** Ass. Prof. of internal medicine and nephrology , faculty of medicine, Suez Canal University, Ismailia, Egypt; *** Ass. Prof. of pathology; faculty of medicine, Suez Canal University; **** resident of internal medicine, Suez canal university hospital, Ismailia Egypt

Correspondence Address :
Hamdy Ahmed Sliem, E-Mail: hamdy.sliem@yahoo.com
Tel +20107612359

Abstract

Background: The histopathological examination of biopsied kidneys is a gold standard for renal diagnosis. Currently, there is a lack of long-term data collection and studies on renal diseases, whether on glomerular or other forms. Therefore, the present study was designed to determine the histopathological profile of nephropathy in a single large center in Egypt in the last 14 years and to discuss the differences from other countries.
Methods: The study was a retrospective descriptive study. The demographical and clinical data were analyzed for all patients who underwent renal biopsy in the renal unit of the Suez Canal University Hospital. The records of the renal biopsies which were performed for them at the hospital from January 1996 until the end of December 2009 were retrospectively analyzed.
Results: The mean age of the patients was 27.19 ± 14.31 years; 57.14 % were females and 42.86% were males. The most common indication of the kidney biopsy was nephrotic syndrome (43.1%), with the predominance of membranoproliferative glomerulonephritis (MPGN). The second indication was asymptomatic urinary abnormalities (AUA), (25.18%) and the third one was acute renal failure (15.98%). In all biopsies, MPGN was the most prevalent pathological diagnosis (38.74%), followed by membranous glomerulonephritis (22.76%). Lupus was the first co-morbid disease and the most frequent secondary glomerulonephritis.
Conclusion: Discussing the Egyptian registry for renal biopsy will help in increasing the understanding of the histopathology of renal diseases in Egypt in general and in the region of the Suez canal and Sinai in particular. Meticulous interest should be paid to AUAs, as about half of them had MPGN.

Keywords

biopsy; glomerulopathy; kidney disease

How to cite this article :

HAMDY AHMED SLIEM*, GAMAL AHMED TAWFIK**, MAHA ATWA*** Mohammed Mostafa . THE HISTOPATHOLOGICAL PROFILE OF KIDNEY DISEASES IN A SINGLE CENTER IN EGYPT: AN OVERVIEW OF 14 YEARS OF EXPERIENCE. Journal of Clinical and Diagnostic Research [serial online] 2011 April [cited: 2018 Nov 17 ]; 5:295-300. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2011&month=April&volume=5&issue=2&page=295-300&id=1212

Introduction
Renal biopsy remains the main diagnostic tool for renal diseases, which plays a major role in determining the management and the prognosis of parenchymal renal disease. It is the best way to monitor glomerular disease trends and to make policies for the early detection and the control of existing glomerular diseases. Therefore, histological examination of the biopsied kidneys has remained the gold standard for the diagnosis of renal diseases as yet (1)(2)(3).
Many studies and reports from different countries show that the incidence of renal diseases varies according to population, demographical characteristics, environmental factors, socio-economic status and the prevalence of infectious diseases (4)(5)(6)(7)(8)(9)(10)(11). Currently, there is a lack of long-term data collection and studies on renal diseases, whether on glomerular or other forms. The present study was aimed at determining the histopathological profile of nephropathy in a single center in Egypt in the last 14 years and to discuss the differences from other countries. This is the first published study that reports the pattern of nephropathy in the Suez Canal area and Sinai. The current documented data may serve a resource for physicians and healthcare providers in their practice to improve the management of renal diseases.

Material and Methods

Patients and methods:
This study was a retrospective, descriptive study. The demographical and clinical data were analyzed for all patients who underwent renal biopsy in the renal unit of Suez Canal University Hospital. The records of renal biopsies which were performed for them at the hospital from January 1996 until the end of December 2009 were retrospectively examined. The hospital is a referral center for five governorates in Egypt (3 in the Suez Canal region and 2 in Sinai). It is a 600-bed, tertiary university, teaching hospital. The Suez Canal region and Sinai have a population of about 6 million people. The renal biopsy specimens were stained and analyzed by light microscopy. Both immunohistochemistry using polyclonal antisera against human IgG, IgM, IgA, C3, and electron microscopy were not systematically or routinely performed. All specimens were examined by at least two senior expert staff in both the renal and the pathology departments.
The indications for renal biopsy were categorized into nine clinical syndromes: nephrotic syndrome (NS), acute nephritic syndrome, mixed, asymptomatic urinary abnormalities (AUA) or haematuria, acute renal failure (ARF), chronic renal failure (CRF), accidentally discovered impaired kidney function (IKF), and malignant infiltration.
NS was defined as proteinuria >3.5g/day and hypoproteinemia. Acute nephritic syndrome was defined as haematuria, hypertension, oedema, oliguria and reduced glomerular filtration rate. AUA encompassed non-nephrotic proteinuria with or without microscopic haematuria. ARF was defined as a sudden and rapid deterioration of renal function, while CRF was considered when elevated serum creatinine persisted for >6 months [ 2],(4),(11).
The histopathological diagnoses were classified into four major categories: Glomerulonephritis (primary/secondary), interstitial nephritis (acute/chronic), deposit nephropathy (amyloidosis/ malignant infiltration) and miscellaneous. Miscellaneous pathologies included end-stage renal disease (ESRD), acute tubular necrosis (ATN), acute cortical necrosis, renal infarction, and diabetic nephropathy.
GN had been classified into ten pathologies: Minimal change GN, focal segmental glomerulosclerosis (FSGS), membranoproliferative glomerulonephritis (MPGN), membranous glomerulonephritis (MGN), poststreptococcal glomerulonephritis (PSGN), rapidly progressive glomerulonephritis (RPGN), diffuse proliferative GN, focal proliferative GN, mesangioproliferative GN, and acute exudative GN.
Data analysis: The data were coded and organized. The final study results were stated by using the SPSS program, version 14. The results were presented through tables. The Chi-square test was used for the qualitative variables, while the independent t-test was used for the quantitative variables. Statistical significance was considered at P-values <0.05 and a higher significance at P-values <0.001.
Ethical consideration: The study protocol was approved by the hospital ethics committee. The data were collected after taking the permission from the hospital authorities. The names of the patients were omitted (anonymous). All data were used for scientific purposes only.

Results

During the period of 14 years, and after exclusion of the cases with inadequate data collection or insufficient sample material, 413 biopsies from native kidneys were analyzed. The mean age of the patients was 27.19+14.31 years; 57.14 % were females and 42.86% were males. 47.44 % had no co-morbid conditions. The most frequent co-morbidity was systemic lupus (SLE), representing nearly one quarter (24.21%) of the patients, followed by hypertension (14.8%) , chronic liver disease (4.1%) and diabetes (2.4%). A majority of the biopsies were done with a closed, percutaneous ultrasound guided technique, which represented 96.86 % of the biopsies, while 3.14 % were open biopsies. The mean number of glomeruli was 13.78 (Table/Fig 1): presents the laboratory profile of the patients at the time of biopsy. The mean value of serum creatinine was 3.3+4.47 mg%.
(Table/Fig 2) shows that the most common indication of the kidney biopsies was nephrotic syndrome which comprised nearly half of the indications of the biopsies (43.1 %), followed by asymptomatic urinary abnormality and acute renal failure (25.18 % and 15.98 % respectively). The rarest indication was malignant infiltration, which formed 0.73 % of all the biopsies.
(Table/Fig 3) shows that MPGN was the most prevalent pathological diagnosis, representing more than one third of the cases (38.74 %), followed by MGN (22.76 %).(Table/Fig 4): shows the frequency of different biopsy proven renal diseases per year. MPGN and MGN were still the most prevalent diseases per year. The fluctuations from year to year were non-significant.

(Table/Fig 5) presents the distribution of the different histopathological patterns according to the indications of the biopsies. Nephrotic syndrome and asymptomatic urinary abnormality were the main indications for MPGN and MGN. , which were the most common pathological diagnoses representing 43.26 % and 33.71 % for nephrotic syndrome and 49.04% and 15.38% for asymptomatic urinary abnormality, respectively. PSGN was represented nearly equally by either pure nephritic or mixed nephrotic / nephritic presentations. ARF was the only presentation for ATN, acute cortical necrosis, acute interstitial nephritis and renal infarction.

Discussion

In the current study, the registry of the renal unit and the medical files of the patients which were recovered from the central registry unit of the Suez Canal University Hospital were used to review all the clinical, laboratory and renal histopathological data.
It was noted that most of the biopsies were done in adults above the age of 18 years, which represented 87.65 % of the biopsies, which suggested either a higher age of onset of the renal diseases, especially the glomerular diseases, or a very strict criteria for biopsying the paediatric patients. This was the same as reported from Czech (4) , Serbia (5), Italy(6) , France (7) and Romania(8), but this was not the case in Korea(9) and Japan(10), where the paediatric contributions were 40.5 % and 20 % respectively, out of all the renal biopsies.
The observed female gender predominance over the male gender in the current study may be due to the high incidence and prevalence of SLE with lupus nephritis, which is much higher in females than in males. Nearly one quarter of our patients (24.21%) had SLE. Such a female predominance is coincident with reports from previous studies which were done in Egypt(11) , but in opposition to most reports from the European countries, which show on one hand, a balanced gender distribution as seen in Serbia (5) and in Romania(8) and on other hand, a male gender predominance as seen in Italy(6) and Czech(4).
The mean number of glomeruli which were seen in our study was 13.78 ± 1.23, which is much higher than that reported from other centers. In Romania, the mean number was 9.1 ± 4.9 (8). This reflects more accurate biopsies with regards to the technical and histopathological diagnosis.
By analyzing the current data, it was found that the most common indication of renal biopsy was nephrotic syndrome, representing 43.1 % of all the cases, followed by asymptomatic urinary abnormalities (25.18 %) and ARF (15.98 %). These results agree with those from previous studies done by Barsoum and Francis in Cairo, Egypt (11). Nephrotic syndrome represented 31.9 % of the cases in their study. In Arabian countries, the predominance of the nephrotic syndrome was clear. In Jordan, it represented 51.6 % of the cases (12) and in the United Arab Emirates, it represented 54 % of the cases (13). Outside the Arab world, the presence of nephrotic syndrome as the main indication of the biopsy, was comprehensible, as shown by reports from Serbia (36.92 %)(5) , Romania (52.3 %) (8), Senegal (67 %)(14) and Brazil (42 %)(15). Regarding the renal biopsy pattern, MPGN was found to be the most histopathological feature of nephrotic syndrome in our data (43.26), followed by MGN (33.71). Nevertheless, there was a marked difference in the diagnosis of these cases from the histopathological diagnosis of the cases with nephrotic syndrome in other studies. IGA nephropathy was the main cause of nephrotic syndrome in most European reports, with the exception of Italy (6) and Macedonia (16), where MGN represented 32.9 % and 13.5 % of the cases respectively, while FSGN was the main feature in reports from Africa (14).
The second common cause for the renal biopsy was AUA, representing 25.18 % of the cases. About 49 % out of them showed the pathological diagnosis of MPGN. This reflects the policy of the nephrology unit of the Suez Canal University Hospital to detect the renal disease early in its course. In other parts of the world, the same picture was noted. In Czech represented 36.2 % (4) , rather higher than that observed in Italy 30.8 % (6). It represented 36.2% in Czech(4) and 30.8% in Italy(6). Much higher percentage was observed in reports from Japan (48.1 %)(10). As a picture of dissimilarity, AUA accounted for only 3.3 % of the cases in Romania (8).
ARF was the third indication for kidney biopsies, representing 15.98 % of all the biopsies and 19.69% of them had the pathological feature of ATN. The striking feature was MPGN, followed by MGN, which can be attributed to the actuality that patients with MPGN and MGN constitute 61.5% of all the studied biopsies. It is also striking that acute cortical necrosis and acute interstitial nephritis account for 7.58% and 1.52 % of the cases. This may be explained by the policy of using kidney biopsy as a diagnostic tool in patients with acute renal failure, when the course is atypical or the insult is unknown, while patients with conventional insults (e.g. : pregnancy complication, systemic inflammatory response syndrome, drugs,…etc) are not routinely biopsied. Reports from Romania showed a figure which was close to that found in the present study (8).
The nephritic syndrome and the mixed nephrotic/nephritic presentation represented 3.63 % and 2.91 % of the cases respectively, in the present study. This is relevant to the old Italian survey which showed that nephritic syndrome accounted for 4.02 % of the cases and the pathological diagnosis was mainly PSGN and IGA nephropathy with minor cases of necrotizing vasculitis and crescentic GN (6). These data were in harmony with our results, which showed that PSGN accounted for 26.66% and 25% of both the presentations. This was found to cope up with the natural history of the disease. Such a prevalence of nephritic syndrome is much less than in the Romanian reports, which showed that nephritic syndrome accounts for 21.9 % of the cases (8). That could be attributed to the low socioeconomic status and the subsequent high prevalence of the infectious processes.
In general, the present study emphasizes a strong geographical variation of the renal histopathological pattern. It showed that MPGN represented 38.74 % of all the cases, followed by MGN (22.76 %). In Arabian countries like Bahrain, minimal change GN and FSGN constituted the highest frequencies (17). In Jordan, FSGN was the main diagnosis, accounting for 27.3 % of the cases, followed by MPGN, which accounted for 21.2 % of the cases (12), which agreed with reports from Saudi Arabia (18) and Sudan (19). This is in contrast to most European studies, which showed that the most common pathological diagnosis was IGA nephropathy, which mainly involved the western and central European countries with a variable percentage. For example : 37 % in Italy(6) , 34 % in Czech(4) , 17% in Spain(20) and 15% in Lithuania (21), while the eastern countries showed variable diagnoses, as the most common one in Romania was MPGN (29 %)(8) and that in Serbia was MGN (21.6%)(5). These variations can be attributed to ethnic and social discrepancies. In Africa, as in Senegal, due to the predominance of the black race more than other ethnic populations, FSGN was the main diagnosis. It accounted for 67% of the primary glomerulonephritis cases (14). In Australia (22) and USA (23), the most common diagnosis was IGA nephropathy, which accounted for 34% and 21% of the reported cases. This figure is relevant to the European series and can be attributed to the fact that the US and the Australian population had an original European ethnicity. In Asia, studies done in China (24),(25) and Korea (9) revealed that IGA nephropathy was the most common pathological abnormality, accounting for nearly 50.7 % and 28 % of the cases respectively. which further emphasis the ethnic factor.
Furthermore, there are regional variations inside the same country as in Egypt. MPGN was the most frequent diagnosis in the Suez canal area and in Sinai, in contrast to other studies, which revealed that FSGN was the most frequent diagnosis in the Cairo area (11). Many reports from other countries supported this hypothesis of regional variation. In Brazil, FSGN was found to be very common in the central region (26.9 %), while MGN was common in the north (29.6 %) and IGA nephropathy was common in the south (22.8 %)(15).
A striking feature in the age distribution of the glomerular diseases was observed in our study. Minimal change GN was 62.85 % in adults above age of 18 years. This was relevant to a study which was done in Pakistan (26), but was different from one which was done in UK, which showed that minimal change GN was the third in rank, accounting for only 9.8 % of all the adult primary glomerular diseases, while IGA nephropathy and MGN accounted for 38.8 % and 29.4 % of all the adult primary glomerular diseases respectively (27). Such a high prevalence of IGA nephropathy was due to the fact that IGA nephropathy was the most prevalent glomerular disease in UK in all age groups.
GA nephropathy was reported to be the commonest type of glomerulonephritis in several parts of the world, but it did not appear to be so in our study. This may be attributed to the fact that immunofluorescence studies were not routinely done in our pathology units. In addition, this was attributed by the clinical policy of not subjecting the patients to an expensive or invasive procedure without significant reflection on their diagnosis and treatment.
Chronic interstitial nephritis was noted in 2.91 % of the cases. It was the most common cause of CRF and 91.67% of them were adults. This was germane to a study done in Serbia, which emphasized that the disease starts at a younger age and progresses to a full blown picture of CRF in adults. Nevertheless, it should be taken into consideration, that cases of Balkan endemic nephropathy were reported, as was chronic interstitial nephritis (5). From earlier studies from Cairo, Egypt, it was reported that the prevalence of chronic interstitial nephritis was much higher, which comprised of 11 % of the cases, which reflected an increased medical awareness in the patients due to their urban background (11). Regarding amyloidosis, it was found to account for 3.15 % of our cases. All of them were adults. This is very close to the figure reported from Spain, which showed that amyloidosis occurred in 3.3 % of the biopsied patients, but this was less than the figure reported from Lithuania, where amyloidosis was reported in 8.6 % of all the renal biopsies (21). The rarest features in our data were acute exudative glomerulonephritis and diabetic nephropathy. This can be explained by our policy that patients with long standing diabetes, showing nephrotic manifestation, were not routinely biopsied, especially if they had the manifestation of microangiopathy as retinopathy.
Nearly one quarter of our patients had SLE as a co-morbid condition. It is the most common cause for secondary glomerulonephritis. Similar results were reported by Rahbar from the west of Iran (2). Despite hypertension as the second most frequent co-morbid condition, we reported no cases of hypertensive nephrosclerosis. This was supported by a group of studies done in several countries like Brazil (15) , Saudi Arabia (18), Sudan(19) and Serbia(5).

Conclusion

The most common indication of the kidney biopsies was nephrotic syndrome, followed by AUA and acute renal failure. The rarest indication was malignant infiltration. MPGN was the most prevalent pathological diagnosis, representing more than one third of the cases, followed by MGN. A majority of the patients were females and the most common clinical presentation among them was nephrotic syndrome. SLE was the most common secondary cause of MPGN and MGN. Nevertheless, particular interest should be paid to AUAs, as about half of them had MPGN.
Limitation of the study: The main drawback and limitation of the study was that, an immunofluorescence setup or an electron microscope were not available to study a majority of the patients.
Recommendation:
Developing a well-structured national Egyptian registry for renal biopsies through the collection of data from various regional nephrology units for two purposes. First, to draw the map of the renal diseases which are prevalent in Egypt. Second, to catalogue the histopathological findings made by common diagnostic codes like those suggested by the European Dialysis and Transplantation Association. To avoid misdiagnosis and failure and to make some important diagnoses, immunofluorescence should be available.

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