location: nan, 'Thailand 
year: 2016 source: HSRI 
title: Improvement of Clinical Outcome in Kidney Diseases via On-line Thai Glomerular Disease Registry 
abstract:Background: End stage renal disease (ESRD) cause the high morbidity, mortality, and cost in health
care system. The prevention of chronic kidney disease/ESRD is the early recognition and
appropriate treatment of the etiology disease. Glomerulonephritis (GN) is the third most common
cause of ESRD in Thailand comparable to the Western country. The development of qualified
registry and GN network may improve the health care service and accurate epidemiological data
that support the further studies in both clinical and translational research.
Objective: To develop web-based On-line Thai Glomerular Disease Registry for studying the
epidemiology and clinical outcomes of glomerular diseases in Thailand. To develop Thai
Glomerular Disease Collaborative Network (TGDCN) through the country for creating the GN
database and supporting together in taking care of the patients. To perform the clinical
recommendation in GN management.
Methods: TGDCN originally consists of 9 tertiary care centers. We developed the Web-based
Online registry to collect the data from all native kidney biopsy-proven GN patients with aged >
18 years after approval by the ethical committee of each site. We recorded the demographic data
including gender, age, education, native habitat and the laboratory tests including serum
creatinine, albumin, cholesterol, urinalysis, proteinuria, serology tests and the pathological
findings. The clinical outcomes including remission, flare, doubling of serum creatinine, renal
survival, and patient survival were investigated.
Results: We recruited 666 patients performed kidney biopsy during Jul 1, 2014 to Jun 30, 2015.
The female to male ratio was 2.16:1. The mean age, creatinine, albumin, and cholesterol were 42
(18-82) years, 1.4 (0.4-13) mg/dL, 2.9+0.8 g/dL, and 296+118 mg/dL in respectively. The median
proteinuria was 3.2 g/day and ranged 0-22 g/day. The patients presented with 34% of nephrotic
syndrome, 22% of nephritis, 21.7% of nephrotic nephritis, 52% of renal impairment (creatinine >
1.2 mg/dL), and 54.4% of new or aggravated hypertension. The renal pathological findings showed 38% of lupus nephritis (LN), 17.6% of IgA nephropathy (IgAN), 9% of focal segmental
glomerulosclerosis (FSGS), and 8.9% of membranous nephropathy (MN). The mean age of LN,
IgAN, FSGS, and MN were 34, 38, 46, and 50 years. The average creatinine at biopsy of LN, IgAN,
FSGS, and MN were 1.9, 2.4, 2.4, and 1.1 mg/dL. Due to the time limited, the clinical outcomes
were not described at this time.
Conclusion: Our study described the first three common renal pathological findings including LN,
IgAN, and FSGS They were in the working age and presented with the initial renal impairment at
kidney biopsy. This might be the severity of the disease or the delay in performing biopsy due to
limitation of facility in kidney biopsy procedure and referring system. In addition to the data from
Thailand Renal Replacement Therapy (TRT), LN, IgAN, and FSGS were the most common GN
causing the ESRD in our country. Early diagnosis and proper management should be improve the
clinical outcomes among these patients.