#2365 Spectrum and prevalence of renal pathologies: a retrospective analysis of biopsy data from a tertiary care center in India
Authors: Tiwari Vaibhav , Sharma Yogita , Bhalla A K 
Published: May 2024

Abstract

Background and Aims
Renal biopsy remains a cornerstone in diagnosing various nephropathies, providing vital insights into disease etiology and guiding therapeutic strategies. In India, where the burden of renal diseases is on the rise, characterizing the spectrum of renal pathologies through biopsy can significantly influence clinical outcomes. Despite increasing global data on kidney diseases, regional variations exist, and localized data from tertiary care centers in India are sparse. The primary objective of this study was to delineate the spectrum of renal diseases diagnosed via biopsy at a tertiary care center in New Delhi, India, over a seven-year period.

Method
This retrospective study analyzed records from a tertiary care center in New Delhi, India, from 2015 to 2022. Data were extracted from paper-based records and electronic medical records (EMR). The study included patients who underwent native kidney biopsy during this period. Graft biopsies and biopsies with inadequate samples were excluded. Biopsies were evaluated by nephropathologists, and diagnoses were categorized based on standardized criteria.

Results
Between 2015 and 2022, 1,174 renal biopsies were analyzed from patients aged 1.3 to 82 years, with an average age of 40.5 years, showing a male predominance (60%). Chronic Interstitial Nephritis was the most prevalent diagnosis at 14.58%, followed by Diffuse Global Glomerulosclerosis at 13.13%, and IgA Nephropathy at 12.77% (Table 1). In IgA Nephropathy patients (n = 141), the majority exhibited microhematuria (53.9%) and subnephrotic proteinuria (56.02%), while 24.82% presented with nephrotic range proteinuria. Lupus Nephritis was the most common secondary glomerular disease (6.34%). Within the Lupus Nephritis subgroup (n = 70), Class IV (34.29%) and Class V (24.28%) were the most observed classes, with a notable presence of combined Class III+V (10%) and Class IV+V (8.57%). Within the cohort, the most common primary glomerulonephritis diagnosed in the age group of 18-30 years was IgA Nephropathy. For the 30-60 years demographic, Membranous nephropathy was most frequently identified, while in those older than 60 years, Diabetic Glomerulosclerosis was predominant. In cases presenting with hematuria (n = 417), IgA Nephropathy was identified in 17.74%. Among those with rapidly progressive renal failure (n = 79), Pauci immune GN accounted for 46.83% of diagnoses, followed by IgA Nephropathy at 15.18%. For patients with nephrotic range proteinuria (n = 139), IgA Nephropathy, Membranous nephropathy, and FSGS were leading diagnoses, each accounting for 12.94%, 12.23%, and 12.23% respectively.

Conclusion
The analysis revealed IgA Nephropathy as the most common histopathological finding in renal biopsies. The primary indication for biopsy is nephrotic range proteinuria. In this category, IgA Nephropathy is also the most prevalent diagnosis. For patients with rapidly progressive renal failure, Pauci immune GN is the most frequent finding. Additionally, IgA Nephropathy is the leading cause in patients presenting with hematuria. Lupus Nephritis is the most common secondary glomerular disease with class IV being the most common biopsy finding. The study underscores the necessity for continued surveillance of renal pathology trends to inform healthcare strategies in India.