Effects of clinical, laboratory and histopathological findings on prognosisin patients with biopsy-proven primary glomerulopathy

Introduction and Objective: Primary glomerulonephritis (GN) is an important cause of end-stage renal disease (ESRD) which requires renal replacement therapy. It is important to know the factors affecting kidney survival in primary glomerulonephritis for treatment strategies. In this study, we examined the factors affecting kidney survival in patients with primary glomerulopathy. Material and Method: We included 80 primary GN patients diagnosed with biopsy at Akdeniz University Hospital Nephrology Department between January 2015 and June 2019 in this study. It is a single center retrospective study. Patients with at least 12 months follow-up were included. The primary endpoint was the access to renal replacement therapy or the development of ESRD that needed these treatments. The statistical significance level was accepted as 0.05 in the study. Results: In this study 43 (53.7%) of the patients were male and 37 (46.3%) were female. The mean age was 45.54 ± 14.32 and the median age was 46. Among 8 patients who developed ESRD, 7 (16.3%) of them were male and 1 (2.7%) was female (p <0.05). There were 26 (32.5%) patients who smoked and ESRD developed in 6 (23.1%) smoking patients (p <0.05). Although there was no statistically significant relationship between patients with hypertension and ESRD (p> 0.05), lower renal survival was statistically significant in patients with office blood pressure measurement ≥140 / 90 mmHg at admission (p <0.05). 3 patients (37.5%) with nephritic syndrome, 2 patients (4.3%) with nephrotic syndrome, 3 patients (30%) presenting with mixed nephrotic and nephritic syndrome progressed to ESRD and worse renal survival in nephritic syndrome was statistically was significant (p <0.05). Patients with high average serum creatinine and parathyroid hormone (PTH) levels at admission had worse renal survival (p <0.05). There was no statistically significant relationship between proteinuria level and ESRD at admission. The lower rate of remission was statistically significant in patients with high proteinuria levels during the follow-up (p <0.05). In the histopathological evaluation of kidney biopsies, 20 patients (25%) had moderate interstitial fibrosis and ESRD was observed in 6 (30%) of them (p <0.05). Remission (complete or partial) could not be achieved in 26 patients (32.5%) with the treatment given, and as a result, 8 (30%) of 26 patients progressed to ESRD (p <0.05). Conclusion: Worse renal survival observed with male gender, smoking, presenting with nephritic syndrome, high blood pressure, severity of interstitial fibrosis in biopsy and in patients whom remission could not be achieved with treatments. More comprehensive studies are needed on the overall and renal survival of primary GN.