Investigation of factors affecting treatment and prognosis in biopsy-proven glomerulonephritis patients

Purpose: Glomerular diseases, also known as nephritic and nephrotic syndrome, are responsible for the majority of kidney diseases. Glomerular disease can be asymptomatic or can be seen in severe forms such as end-stage renal disease, which is one of the serious causes of mortality and morbidity. The disease presents a wide range of clinical symptoms. The disease, which occurs in severe forms up to end-stage renal disease, is likely to cause mortality and morbidity. A wide variety of factors, immunological or non-immunological, hereditary or not, play a role in etiology. Primary glomerular diseases are one of the important causes of end-stage renal disease (ESRD). In the 2021 joint report of the Ministry of Health of the Republic of Turkey and the Turkish Nephrology Association (TND), glomerulonephritis (GN) was shown to be the cause of ESRD in 3.31% of hemodialysis patients and 13.65% of kidney transplant patients [1]. However, a significant portion of ESRD patients whose etiology is reported as hypertension are thought to be chronic GN patients [2]. In this study, we aimed to prospectively examine the demographic characteristics, laboratory course, clinics, and effectiveness of the treatments of patients with primary glomerulonephritis diagnosed by percutaneous kidney biopsy at Akdeniz University Faculty of Medicine, Department of Nephrology. Materials and Methods: In our study, patients diagnosed with biopsy-proven glomerulonephritis at Akdeniz University Hospital between 01.01.2014 and 20.09.2023 were retrospectively examined. Physician notes, dermographic characteristics, laboratory values and treatment data of the patients were accessed through the hospital's automation system and patient files. Among the patients screened, patients who were 18 years of age or older, had chronic kidney disease, had complete data, and had biopsy-proven glomerulonephritis were included in the study. Among the screened patients, those who were younger than 18 years of age, did not have biopsy-proven glomerulonephritis, and had missing data were not included in the study. Data IBM SPSS Statistics 25 © Copyright SPSS Inc. Analyzed using 1989, 2017 software. The suitability of continuous variables to normal distribution was examined with the Kolmogorov Smirnov test. Categorical variables included in the study are presented with frequency (n) and percentage (%), and continuous variables are presented with mean±standard deviation (SD), median (IQR 25-75) and minimum and maximum values. In two independent group analyses, Independent Samples T Test was used for data showing normal distribution and Mann Whitney U Test was used for data that did not. Kruskal-Wallis H test was used for comparisons of more than two independent groups that did not show normal distribution. According to the results of the Kruskal Wallis H test, Post-Hoc Bonferroni correction was run. In the analysis of independent categorical variables, Pearson Chi-Square Test, Yates Correction, Fisher's Exact Test, Fisher's Freeman Halton Exact Test, Post Hoc Bonferroni correction were used. In the study, the statistical significance level was accepted as 0.05. Conclusion: When we look at the demographic data in our study, it was seen that the mean age of the patients was 44.66 ± 15.48 years, the youngest being 20 years old and the oldest being 83 years old, and 57% of the patients in the study were men. The most common disease type was FSGS with 58.5%. Membranous Nephropathy followed FSGS with 23%, MPGN with 10.4% and IgA Nephropathy with 8.1%, respectively. When the Proteinuria Response Status and GFR at the 6th and 12th months were compared, the GFR in the group whose proteinuria did not improve (non-response) at the 6th and 12th months was found to be lower than the group whose proteinuria improved (responsive), this difference was statistically significant. However, no significant difference was found in terms of mortality at 6 and 12 months depending on proteinuria response status. When treatment response was examined, at the 12th month, the combined use of MMF and Azathioprine was found to be higher in unresponsive patients (31.9%) than in partial response patients (0%). This difference was statistically significant. On the other hand, at the 6th month, the treatment type that showed a significant difference according to proteinuria response status was Rituximab and methylprednisolone. When the laboratory values at the 6th month were examined, although the BUN value was found to be significantly higher in the non-responsive group compared to the responsive group, no statistically significant difference was detected between the groups in other parameters (GFR, creatinine, proteinuria, CRP, albumin, calcium, phosphorus, LDL, PTH, HBA1C). When the Laboratory Values at the 12th Month were examined, proteinuria, CRP, BUN, phosphorus and LDL levels were found to be significantly higher in the non-responsive group, and GFR, albumin, calcium and PTH levels were found to be significantly lower in the non-responsive group. No statistically significant difference was detected between the groups in creatinine and HBA1C values. No statistically significant difference was detected between the groups in creatinine and HBA1C values. When comorbidities were evaluated, comorbidities such as hypertension, hyperlipidemia and coronary artery disease (CAD) were seen to be more common in the unresponsive group than in the proteinuria-responsive group, and this difference was statistically significant. No statistically significant difference could be detected between the proteinuria responsive and unresponsive groups at the 6th and 12th months in terms of age and gender. These results indicate that proteinuria response status has significant effects on renal function and laboratory parameters. It is understood that proteinuria control plays a critical role in preserving renal function and should be taken into account in the treatment planning of these patients.