Histopathological Association between Vascular Hypertensive Changes and Different Types of Glomerulopathies.

INTRODUCTION: The term hypertensive nephrosclerosis has traditionally been used to describe a clinical syndrome characterized by long-term essential hypertension, hypertensive retinopathy, left ventricular hypertrophy, minimal proteinuria, and progressive renal insufficiency. In the absence of renal biopsy, the diagnosis of hypertensive nephrosclerosis is one of exclusion. METHODS: We retrospectively studied 735 patients who had renal biopsies at Ain Shams University Hospitals between January 2008 and Dec 2010. The prevalence of vascular hypertensive changes was studied in relation to clinical presentation and the glomerular pathology pattern. RESULTS: Male to female ratio was 1:1 and the mean age was 27±17 years. No vascular hypertensive changes were found in 44.5% of biopsies while mild, moderate and severe changes were found in 28%, 22% and 4.2% respectively. Malignant hypertensive changes were seen in 1.2% of biopsies. Lupus nephritis was the most common etiology representing 18.9% of all cases, followed by focal segmental glomerulosclerosis (FSGS) (13.5%), membranoproliferative glomerulonephritis (13.3%) and membranous glomerulonephritis (8.2%). Moderate to severe vascular hypertensive changes were more common in biopsies with FSGS compared to other glomerulopathies. Hypertensive nephrosclerosis as the sole cause of renal failure represented only 1.6% of cases. Significant associations were found between the degree of vascular hypertensive changes and the grade of hypertension. Patients with severe vascular hypertensive changes were significantly older and had significantly higher serum creatinine levels compared to other groups. CONCLUSION: History and grade of hypertension significantly influence the degree of vascular hypertensive changes in renal biopsy. Moderate to severe vascular hypertensive changes were more common in biopsies with FSGS compared to other pathologies. KEYWORDS: Hypertension; Nephroangiosclerosis; Renal Biopsies.

Dense deposit disease: a 29-years electron microscopy experience.

INTRODUCTION: Dense Deposit Disease (DDD) is a devastating renal disease that leads to renal failure within 10 years of diagnosis in about half of affected patients. In this study, we evaluated the relative prevalence and pathological features of DDD diagnosed at our center over a 29 years period. METHODS: We reviewed the clinical and pathological features of all cases of DDD diagnosed at the Electron Microscopy Unit of Ain Shams University (ASUSH) between January 1983 and December 2011. RESULTS: From a total of 3283 renal biopsies, 33 (1%) were diagnosed with DDD (10 children and 23 adults). Nephrotic syndrome was the predominant clinical presentation of DDD (51.5%), and was commoner in children than adults (80% vs. 43%, p=0.03). Capillary wall thickening was seen in all cases (100%). Crescents were more commonly seen in children than adults (70% vs. 21.7%, p=0.008) while interstitial fibrosis was more commonly seen in adults (78.3% vs. 40%, p=0.03). The commonest histological pattern seen under light microscopy was membranoproliferative (27.3%), followed by crescentic (21.2%), membranous (21.2%), diffuse proliferative (18.2%), lobular (6.1%) and mesangial proliferative (6.1%) patterns. Immunohistochemistry was available for 25 cases and showed intense linear staining for C3 along capillary walls. Electron microscopic examination revealed glomerular basement membrane (GBM) thickening and intra-membranous and tubular basement membrane deposits in all cases (100%). CONCLUSION: DDD is a rare disease in Egypt, found in only 1% of renal biopsies. Pathological features of the disease differ between adults and children; children have predominantly glomerular damage whereas tubuleinterstitial lesions are more often encountered in adults.