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Fulltext Biopsy-proven childhood glomerulonephritis in Johor

Khoo JJ, Pee S, Thevarajah B, Yap YC, Chin CK

Med J Malaysia, 2004 Jun;59(2):218-25.
PMID: 15559173 MyJurnal

Background: There has been no published study of biopsy proven childhood glomerulonephritis in Malaysia.
Objectives: To determine the pattern of childhood glomerulonephritis in Johor, Malaysia from a histopathological perspective and the various indications used for renal biopsy in children.
Materials and methods: Retrospective study was done of all renal biopsies from children under 16 years of age, received in Sultanah Aminah Hospital, Johor between 1994 and 2001. The histopathological findings were reviewed to determine the pattern of biopsy proven glomerulonephritis. The indications of biopsy, mode of therapy given after biopsy and the clinical outcome were studied.
Results: 123 adequate biopsies were received, 9 children had repeated biopsies. Of the 113 biopsies, minimal change disease formed the most common histopathological diagnosis (40.7%) while lupus nephritis formed the most common secondary glomerulonephritis (23.0%). The main indications for biopsy were nephrotic syndrome (50.8%), lupus nephritis (25.4%) and renal impairment (13.1%). The mode of therapy was changed in 59.8% of the children. Of 106 patients followed up, 84 children were found to have normal renal function in remission or on treatment. 4 patients developed chronic renal impairment and 16 reached end stage renal disease. Five of the 16 children with end stage disease had since died while 11 were on renal replacement therapy. another 2 patients died of other complications.
Conclusions: The pattern of childhood GN in our study tended to reflect the more severe renal parenchymal diseases in children and those requiring more aggressive treatment. This was because of our criteria of selection (indication) for renal biopsy. Renal biopsy where performed appropriately in selected children may not only be a useful investigative tool for histological diagnosis and prognosis but may help clinicians plan the optimal therapy for these children.

Matched MeSH terms: Glomerulonephritis/pathology
Fulltext Pattern of glomerular disease in Malaysia

Cheong IK, Chong SM, Suleiman AB

Med J Malaysia, 1981 Mar;36(1):3-7.
PMID: 7321935

This paper reviews the pattern of glomeruler disease from 163 renal biopsies performed at the Institute of Urology and Nephrology. Nephrotic syndrome formed the largest group of patients. There is a high prevalence of SLE nephritis in our community. The histopathologic findings in our series were comparable to those from Western countries except for the lower incidence of membranous and membranoproliferative glomerulonephritis.

Matched MeSH terms: Glomerulonephritis/pathology*
Fulltext Extensive crescent formation in idiopathic membranous glomerulonephritis. A case report

Cheong IK, Chong SM, Singh N, Suleiman AB

Med J Malaysia, 1981 Mar;36(1):8-10.
PMID: 7321940

We report this 21 years old Indian male with the nephrotic syndrome due to membranous nephropathy who later developed numerous epithelial crescents leading to a rapid loss of renal function. The pathogenesis of the crescentic transformation in this type of glomerulopathy is discussed.

Matched MeSH terms: Glomerulonephritis/pathology*
Membranous glomerulonephritis and chronic hepatitis

Wang F, Menon A, Murugasu R, Prathap K

Med J Malaysia, 1977 Sep;32(1):78-81.
PMID: 609351
Matched MeSH terms: Glomerulonephritis/pathology
Immunotactoid glomerulopathy--an unusual deposition disease: report of the first Malaysian case

Cheah PL, Looi LM, Ghazalli R, Chua CT

Malays J Pathol, 1999 Jun;21(1):59-62.
PMID: 10879280

A 31-year-old Malay female presented with nephrotic syndrome without renal impairment. Renal biopsy features were in keeping with immunotactoid glomerulopathy (ITG). Non-Congophilic deposits were seen causing thickening of the glomerular capillary basement membrane with segmental accentuation, and widening of the mesangium. Immunofluorescence examination showed moderate amounts of IgG and C3 in the glomerular capillary walls with some in the mesangium. Ultrastructurally, 20-nm thick fibrils with microtubular organisation were present predominantly in the subendothelial region with similar fibrils in the mesangium. Although immunotactoid glomerulopathy and fibrillary glomerulonephritis (FG) have been recognised as entities with extracellular fibrillary material in the kidney, to date much remains to be clarified regarding these 2 conditions. While the renal biopsy findings in this patient are consistent with ITG, her clinical presentation is unlike that of usual ITG in that she is of a much younger age and has no associated haemopoietic disorder. Response to initial treatment of 8 weeks of prednisolone therapy was poor.

Matched MeSH terms: Glomerulonephritis/pathology
Systemic lupus erythematosus with membranous lupus nephropathy in Malaysian patients

Wang F, Looi LM

Q. J. Med., 1984;53(210):209-26.
PMID: 6463196 DOI: 10.1093/oxfordjournals.qjmed.a067794

Thirty-one patients with systemic lupus erythematosus had membranous lupus nephropathy (MLN). They were divided into two groups. Group I consisted of 13 patients who had pure MLN but the patients in Group 2 had segmental proliferation in up to 35 per cent of their glomeruli. The rest of the glomeruli had purely membranous change. The patients of Group 2 were no different from the other MLN patients in terms of age, sex and race. The extrarenal disease in both groups was extensive and severe. The renal disease was usually associated with the nephrotic syndrome or oedema but was asymptomatic throughout in one patient. Both renal and extrarenal features responded to treatment initially but relapses were frequent and often severe. Relapses often occurred as treatment was discontinued or medication reduced. Survival at six years in Group I was 62 per cent and in Group 2 was 50 per cent. Only one patient died with renal failure although five patients had impaired renal function at death. The chief causes of death were disease of the central nervous system and infection.

Matched MeSH terms: Glomerulonephritis/pathology
Fulltext IGA nephropathy--a clinicopathological review of 12 cases seen at the Department of Nephrology, General Hospital, Kuala Lumpur

Cheong IKS, Chong SM, Suleiman AB

Singapore Med J, 1983 Apr;24(2):109-12.
PMID: 6612354

From a total of 163 renal biopsies there were 12 cases (9.1%) of IgA nephropathy. All of them presented with symptomatic or asymptomatic proteinuria and/or haematuria. The pattern of disease here generally conforms to reports elsewhere. However in contrast it appears to be common in both sexes and the clinical course tends to be more severe In males. The absence of IgG In the glomeruli on immunoffourescence was an unexpected finding. The presence of hypertension, renal insufficiency and glomerulo·interstitial scarring seem to indicate poorer prognosis. There is no known effective treatment.

Matched MeSH terms: Glomerulonephritis/pathology*
Fulltext Glomerulonephritis in Kelantan, Malaysia: a review of the histological pattern

Zainal D, Riduan A, Ismail AM, Norhayati O

Southeast Asian J Trop Med Public Health, 1995 Mar;26(1):149-53.
PMID: 8525403

Renal biopsy is essential in the management of renal parenchymal diseases. Thus far there is no publish report on the pattern of glomerulonephritis in Kelantan. We decided to establish the pattern of glomerulonephritis in Kelantan and use this information as our reference in future studies. Records of patients who had proven glomerulonephritis histologically were analysed. Their biological data, clinical presentation, etiology and clinicopathological pattern were studied. Where appropriate mean and standard deviation were calculated. A total of 74 biopsies were performed during the study period (between January 1991 and December 1993), out of which 72 biopsies (97.3%) were considered suitable for analysis. The male to female ratio was 1:1.1. Mean age at presentation was 27.6 +/- 12.2 years. Nephrotic syndrome was the commonest clinical presentation (65.3%). The main underlying cause was systemic lupus erythematosus (50%) followed by primary glomerulonephritis. Histologically, IgA nephropathy and minimal change disease were the main patterns among patients with primary glomerulonephritis while diffuse proliferative glomerulonephritis was the commonest pattern among patients with lupus nephritis. Hence the pattern of glomerulonephritis is similar to other reported series. The procedure is considered safe and has a high success rate.

Matched MeSH terms: Glomerulonephritis/pathology*
Fulltext Fibrillary deposits: amyloids and tactoids

Looi LM

Malays J Pathol, 1995 Jun;17(1):1-10.
PMID: 8906998

Two forms of abnormal fibrillary protein deposition are considered: amyloidosis and fibrillary (immunotactoid) glomerulonephritis. Amyloid is characterised by an antiparallel, beta-pleated configuration which imparts to it a unique apple-green birefringence after Congo red staining. Inspite of its fairly constant physical properties, the chemical composition of amyloid fibrils is amazingly diverse, encomposing AA protein, light chain fragments, transthyretin, procalcitonin, islet amyloid polypeptide, atrial natriuretic peptides, beta-amyloid protein, beta-2-microglobulin, cystatin C, gelsolin, apolipoprotein A1, lyzozyme and their mutant variants. Amyloid P component and heparan sulphate proteoglycan are ubiquitous non-fibrillary amyloid components which have significant roles in the amyloidogenetic process, as do also precursor fibril proteins. Different amyloid fibril proteins relate to different amyloidosis syndromes and different histological patterns, and provide the basis for new diagnostic approaches to this disorder. Glomerular deposits in fibrillary glomerulonephritis (FGN), although often mistaken for amyloid, differ from it in its negative Congophilia, wider fibril width and highly organised, microtubular-tactoidal appearance ultrastructurally. FGN is essentially a primary glomerulopathy resulting in progressive renal failure. Despite certain differences, intriguing similarities between both entities of fibrillary deposition pose a challenge to researchers as to the mechanisms of abnormal protein crystallization and fibril formation in tissues.

Matched MeSH terms: Glomerulonephritis/pathology*
Morphological patterns of glomerular disease in renal biopsies from 1000 Malaysian patients

Prathap K, Looi LM

Ann Acad Med Singap, 1982 Jan;11(1):52-6.
PMID: 7073229

Adequately biopsied renal tissue received in the Department of Pathology, University Hospital, Kuala Lumpur from 1,000 consecutive Malaysian patients during an eleven year period between 1970 and 1981 was reviewed. The youngest patient was 6 days old and the oldest 80 years. Both sexes were equally represented. The majority of the patients were Chinese (71%) with Malays and Indians comprising most of the remainder. Over half the patients (50.4%) presented with the nephrotic syndrome. Other modes of presentation included systemic lupus erythematosus, proteinuria and haematuria separately or in combination and hypertension. Minimal change (25.7%) and proliferative glomerulonephritis (24.8%) were present in about equal numbers and together accounted for over half of the cases (50.5%). Lupus nephritis was the third most common diagnosis (18.4%). In addition, there were patients with focal glomerulonephritis (5.4%), membranous glomerulonephritis (5.5%), Berger's disease (5.8%), amyloidosis (0.6%) and end stage renal disease (4.0%).

Matched MeSH terms: Glomerulonephritis/pathology
Differentiation of human mesenchymal stem cells into mesangial cells in post-glomerular injury murine model

Wong CY, Cheong SK, Mok PL, Leong CF

Pathology, 2008 Jan;40(1):52-7.
PMID: 18038316

AIMS: Adult human bone marrow contains a population of mesenchymal stem cells (MSC) that contributes to the regeneration of tissues such as bone, cartilage, muscle, tendon, and fat. In recent years, it has been shown that functional stem cells exist in the adult bone marrow, and they can contribute to renal remodelling or reconstitution of injured renal glomeruli, especially mesangial cells. The purpose of this study is to examine the ability of MSC isolated from human bone marrow to differentiate into mesangial cells in glomerular injured athymic mice.
METHODS: MSC were isolated from human bone marrow mononuclear cells based on plastic adherent properties and expanded in vitro in the culture medium. Human mesenchymal stem cells (hMSC) were characterised using microscopy, immunophenotyping, and their ability to differentiate into adipocytes, chondrocytes, and osteocytes. hMSC were then injected into athymic mice, which had induced glomerulonephropathy (GN).
RESULTS: Test mice (induced GN and infused hMSC) were shown to have anti-human CD105(+) cells present in the kidneys and were also positive to anti-human desmin, a marker for mesangial cells. Furthermore, immunofluorescence assays also demonstrated that anti-human desmin(+) cells in the glomeruli of these test mice were in the proliferation stage, being positive to anti-human Ki-67.
CONCLUSIONS: These findings indicate that hMSC found in renal glomeruli differentiated into mesangial cells in vivo after glomerular injury occurred.

Matched MeSH terms: Glomerulonephritis/pathology*
The changing pattern of primary glomerulonephritis in Singapore and other countries over the past 3 decades

Woo KT, Chan CM, Mooi CY, -L-Choong H, Tan HK, Foo M, et al.

Clin. Nephrol., 2010 Nov;74(5):372-83.
PMID: 20979946

This review of 2,586 renal biopsies over the past 3 decades in Singapore documents the changing pattern of glomerulonephritis (GN) from that of a third world country to that of a developed nation. In the 1st decade, mesangial proliferative glomerulonephritis was the most common form of primary GN, just as it was in the surrounding Asian countries. In the 2nd decade, the prevalence of mesangial proliferative GN decreased with a rise in membranous, GN which is also seen in China and Thailand. In the 3rd decade, there was a dramatic increase in focal sclerosing glomerulosclerosis. This increase reflects aging and obesity in keeping with more developed countries like Australia, India, Thailand and the United States of America. IgA nephritis remains the most common GN. Apart from the geographical influence, other socioeconomic factors play a significant role in the evolution of the renal biopsy pattern. Mesangial proliferative GN remains prevalent in many Asian countries, but in Singapore the prevalence is decreasing just as it is in Japan, Korea and Malaysia. Worldwide, the prevalence of focal sclerosing glomerulosclerosis continues to increase in many countries.

Matched MeSH terms: Glomerulonephritis/pathology