#5400 CLINICAL PROFILE, MICROSCOPIC FEATURES AND OUTCOMES OF PATIENTS WITH MINOR GLOMERULAR ABNORMALITIES AT NKTI: A 10-YEAR DESCRIPTIVE CROSS-SECTIONAL STUDY
Authors: Teus Merry Ann , Chua Eric 
Published: June 2023

Abstract

Background and Aims
Minor Glomerular Abnormality (MGA) is a kidney biopsy diagnosis characterized by the presence of minor structural abnormalities which, are not sufficient to be classified under the other known glomerular diseases. Although usually considered a benign renal problem, few literatures mentioned it may cause deterioration of kidney function in the long term. The objective of this study is to describe the clinical profile, microscopy findings, treatment outcome and renal survival of patients diagnosed with Minor Glomerular Abnormalities in NKTI from 2005 to 2015.

Method
This is a Retrospective, Descriptive, Cross-sectional study which included 190 patients who were diagnosed with MGA. Demographic, clinical profile, CKD classification and treatment outcomes were presented using descriptive statistics while renal survival was analysed using Fisher's Exact Test. Based on the level of proteinuria and serum creatinine, treatment outcomes of the patients were classified as either with (1) complete response [if with reduction in proteinuria to ≤ 300 mg/day (&lt;/ = 0.3 g/day) and a creatinine clearance ≥ 80 ml/min with no reduction from baseline] (2) partial response [proteinuria between 300 mg and 3 g/day OR by at least 50% from baseline level and with no deterioration in creatinine clearance], (3) relapse[patients whom (a) after a complete response to treatment (baseline proteinuria ≤ 300 mg/day), there is an increase in proteinuria to ≥ 1.0 g/day or (b) after a partial response (baseline proteinuria between 300 mg and 3 g/day), there is an increase in proteinuria to ≥ 3 g/day or increase in proteinuria by ≥ 50%, or (c) after a partial response (baseline proteinuria &gt; 3 g/day), there is an increase in proteinuria by ≥ 50%], or (4) unsatisfactory response to treatment if complete or partial response is not met. Renal survival was assessed by classifying the renal status of the patients as either with (1) Normal or Mildly Decreased GFR [CKD 1-2] or (2) with moderately decreased kidney function to renal failure [CKD 3-5].

Results
The mean age of the MGA patients at diagnosis was 37 years old. Of the 190 subjects of this study, 53.68% were female and 73.16% has no comorbidities. Proteinuria was the most common reason for consult (66.32%), followed by hematuria (38.42%) and worsening renal function (14.21%). Most of the patients had Nephrotic Syndrome (39%) before biopsy. The top three Electron Microscopy findings were Minimal Change Disease (24.4%) Segmental Podocyte Foot Processes Effacement (True MGA) at 27.4% and Thin Basement Membrane Disease (22.6%). At one year and five years, 13.68% and 4.74% respectively have complete response to treatment while 22.10% and 13.15% respectively have either partial or unsatisfactory response to treatment. Eighty patients (86.02%) at one year and 33 patients (78.57%) at 5 years remain at CKD 1-2. When the renal survival of the True MGA and Non-MGA patients were compared using Fisher Exact Test, there was no significant difference between the two groups (p values of 0.080 at 1 year and 0.99 at 5 years).

Conclusion
Minimal Change Disease is the most common Electron Microscopy diagnosis. Majority have good renal survival, but few progressed to CKD 3-5. Survival between MGA and Non-MGA patients are similar.