November 2000, Journal Club

Changing the Incidence of Glomerular Diseases in Adults

G. Braden, J. Mulhern, M. O’Shea,

S. Nash, A. Ucci & J. Germain

AJKD, Vol 35 No.5:2000; pp 878-83

Background

• For the last 50 years, MN was the leading cause of Idiopathic NS in up to .5 of W and AA adults, whereas FSGS was .1-.15

• 3 academic Ctrs. reported FSGS in AA• No info on sm. urban (< 150 K population)

& rural areas • No info on Hispanics

Methods

• Renal Bx & chart review from 1974-94 at Baystate Med. Ctr. in Springfield, Mass.

• >18 y.o, 2 gm proteinuria/day, 5 yr intervals• Excluded: IVDA, HIV, SS, VUR, meds,

tumors, Hep B, MPGN (2o to cryoglob or hepatitis), collagen, SLE, Crescentic GN, Acute Prolif. GN, Focal necrotizing GN, vasculitis, amyloidosis & fibrilary GN

Results

• Sample: 965, eligible n = 616 adults

• AA catchment pop. in 20 years .056 .065

• 2o FSGS went from 0 in the 1st and 2nd quartiles, to .12 (3rd q) to .06 (4th q)

• 2o MN: .3 in the 1st .12 .15 .06

• No sig. in other 1o Glomerulopathies

• 1990-94 new FSGS 15 vs. MN 7 (p<.05)

Discussion (1): Idiopathic FSGS Increase

Unlikely due to detection (tissue levels on light microscopy/Bx = in 20 years)

Unlikely due to frequency of 2o causes of FSG or MN because these patients along with the idiopathic FSGS cases.

• No in 2o MN that could Idiopathic MN

Discussion (2): Idiopathic FSGS Increase

• FSGS in AA & H (significantly) & in W

• No in age and sex distribution in 20 y.

• Inclusion of all 2 g/d proteinuria, not all patients had NS overestimation

• Most Hispanics from Puerto Rico