Pattern, clinical features and response to corticoids
                    of glomerular diseases in a Brazilian population. An analytical cross-sectional
                    study

Queiroz, Anaiara Lucena; Barreto, Dulce Maria Sousa; Silva Junior, Geraldo Bezerra da; Tavares Neto, José Edísio da Silva; Costa, Francisco Israel; Patrocínio, Régia Maria do Socorro Vidal; Daher, Elizabeth De Francesco; Almeida, Paulo Roberto Carvalho de

doi:10.1590/1516-3180.2013.7360006

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Sao Paulo Medical Journal

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Original Article • Sao Paulo Med. J. 133 (1) • Jan-Fev 2015 • https://doi.org/10.1590/1516-3180.2013.7360006 copy

Pattern, clinical features and response to corticoids of glomerular diseases in a Brazilian population. An analytical cross-sectional study

Perfil, características clínicas e resposta a corticoides das doenças glomerulares em uma população brasileira. Um estudo transversal analítico

Authorship SCIMAGO INSTITUTIONS RANKINGS

CONTEXT AND OBJECTIVE:

Glomerular disease registries are increasing all around the world. The aim of this study was to evaluate the clinical characteristics and treatment response among patients with glomerular diseases followed up in a tertiary hospital in Brazil.

DESIGN AND SETTING:

Analytical cross-sectional study; tertiary-level public hospital.

METHODS:

This study included patients with glomerular diseases followed up at a tertiary hospital in Fortaleza, northeastern Brazil. Clinical and laboratory data on each patient were registered. The response to specific treatment was evaluated after 3, 6 and 12 months.

RESULTS:

The study included 168 patients of mean age 37 ± 14 years. The most prevalent glomerular diseases were focal segmental glomerulosclerosis FSGS] (19.6%), minimal change disease MCD] (17.9%), membranous nephropathy MN] (16.7%) and lupus nephritis LN] (11.9%). The main clinical presentations were nephrotic proteinuria (67.3%) and renal insufficiency (17.9%). The mean proteinuria value decreased after the treatment began. Regarding 24-hour proteinuria on admission, there was no significant difference between patients with a good response and those with no response (7,448 ± 5,056 versus 6,448 ± 4,251 mg/24 h, P = 0.29). The glomerular disease with the highest remission rate was MCD (92%). Absence of interstitial fibrosis presented a strong correlation with remission (remission in patients without fibrosis = 83.4% versus 16.3% in those with fibrosis, P = 0.001).

CONCLUSIONS:

The present study found that the most frequent glomerular disease was FSGS, followed by MCD, MN and LN. The presence of interstitial fibrosis was a predictor of poor therapeutic response.

Glomerulonephritis; Proteinuria; Renal insufficiency; Therapeutics; Glomerular filtration rate

Glomerular disease	n	%
Focal segmental glomerulosclerosis	33	19.6
Minimal change disease	30	17.9
Membranous nephropathy	28	16.7
Lupus nephritis	20	11.9
Immunoglobulin A nephropathy	12	7.1
Membranoproliferative glomerulonephritis	11	6.5
Mesangial glomerulonephritis	10	6.0
Post-infectious glomerulonephritis	8	4.8
Crescentic glomerulonephritis	6	3.6
Amyloidosis	3	1.8
Others	7	4.2
Total	168	100.0

Glomerular diseases	Initial clinical presentation^*						Total
Glomerular diseases	Nephrotic proteinuria	Renal insufficiency	Non-nephrotic proteinuria	Nephritic syndrome	Recurrent hematuria	No data	Total
Amyloidosis	3 (2.7%)^*	-	-	-	-		3
Thin basement membrane disease	-	1 (3.4%)	-	-	-		1
Focal segmental glomerulosclerosis	25 (22.1%)	1 (3.4%)	2 (18.2%)	3 (30%)	1 (50%)	1	33
Crescentic glomerulonephritis	-	5 (16.5%)	-	1 (10%)	-		6
Lupus nephritis	9 (7.9%)	8 (26.7%)	3 (27.2%)	-	-		20
Membranous nephropathy	25 (22.1%)	1 (3.4%)	2 (18.2%)	-	-		28
Mesangial glomerulonephritis	6 (5.2%)	2 (6.6%)	1 (9.1%)	-	1 (50%)		10
Post-infectious glomerulonephritis	1 (0.9%)	4 (13.3%)	-	2 (20%)	-	1	8
HIV-associated nephropathy	1 (0.9%)	-	-	-	-		1
Minimal change disease	29 (25.7%)	-	1 (9.1%)	-	-		30
Membranoproliferative glomerulonephritis	7 (6.2%)	1 (3.4%)	1 (9.1%)	2 (20%)	-		11
Diabetic nephropathy	2 (1.8%)	-	-	-	-		2
IgA nephropathy	2 (1.8%)	7 (23.3%)	1 (9.1%)	2 (20%)	-		12
Others	3 (2.7%)	-	-	-	-		3
Total n (100%)	113 (67.2%) ^†	30 (17.9%) ^†	11 (6.5%) ^†	10 (6.0%) ^†	2 (1.2%) ^†	2 (1.2%)	168

Glomerular disease	24-hour proteinuria
	Admission		End of treatment
	Mean	SD	Mean	SD
Membranous nephropathy	8,640	5,150	4,730	5,190
Focal segmental glomerulosclerosis	7,580	5,230	2,950	3,900
Mesangial glomerulonephritis	7,170	5,570	3,160	5,120
Minimal change disease	7,000	3,550	1,080	2,090
Membranoproliferative glomerulonephritis	6,420	4,350	2,400	2,960
Diabetic nephropathy	6,310	2,420	1,100	-
Post-infectious glomerulonephritis	5,570	5,450	660	570
Lupus nephritis	4,540	2,690	1,930	1,850
Crescentic glomerulonephritis	2,540	990	660	-
Immunoglobulin A nephropathy	2,470	2,240	2,260	3,050
General ^*	6,500	4,510	2,530	3,660

	Glomerular filtration rate (ml/min)	P^*	Proteinuria (mg/24 h)	P^*
Baseline	65.6 ± 38.3	-	6,500 ± 4,510	-
3 months	73.7 ± 33.6	0.011	4,160 ± 4,072	0.001
6 months	77.4 ± 31.8	0.006	2,563 ± 3,380	0.001
12 months	72.3 ± 35.7	0.149	3,376 ± 7,842	0.002

Scheme	n	%
Corticosteroid alone	65	43.6
Antiproteinuric agents	33	22.1
Cyclophosphamide + corticosteroid	22	14.8
Cyclosporine + corticosteroid	14	9.4
Clinical support	11	7.4
Mycophenolate mofetil + corticosteroid	4	2.7
Total	149	100.0

Scheme	n	%
Cyclosporine	17	40.4
Mycophenolate mofetil	11	26.2
Azathioprine	6	14.3
Cyclosporine + mycophenolate mofetil	5	11.9
Cyclosporine + cyclophosphamide	2	4.8
Azathioprine + mycophenolate mofetil + cyclosporine + rituximab	1	2.4
Total	42	100.0

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[1] Address for correspondence: Geraldo Bezerra da Silva Junior, Universidade de Fortaleza (UNIFOR), Av. Washington Soares, 1.321 — bloco S — sala 1, Edson Queiroz — Fortaleza (CE) — Brasil, CEP 60811-905, Tel. (+55 85) 3477-3280. E-mail: geraldobezerrajr@yahoo.com.br