Nisar Anwar, Ahmad Zeb Khan, Amer Azhar, Mian Ayazul Haq.
Renal causes of significant proteinuria in population above 40 years of age.
J Postgrad Med Inst Jan ;19(1):41-6.

Objective: The objective of this study is to highlight the importance of renal biopsy in adult population (above 40 years age) with significant proteinuria due to renal diseases, so that accurate diagnosis and treatment plan can be devised. Material and Methods: This is a retrospective study carried out at the department of Nephrology, Khyber Teaching Hospital, Peshawar. The biopsies carried out between June 1999 and June 2002 were scrutinized. All these were ultrasound guided percutanous renal biopsies. Biopsies carried out in patients with the following findings were included in our study 1. Nephrotic range proteinuria in adults. 2. Non-nephrotic range proteinuria with evidence of hypertension / haematuria / deranged renal function or active sediments on urine microscopy. 3. Patients having age above 40 years. 4. Patients not suffering from Diabetes, Chronic Renal Failure, Adult Polycystic Kidney Disease, or any Congenital Renal Disease. Results: A total of 260 renal biopsies were carried out in the above-mentioned period. Out of these only 56 patients fulfilled the above criteria. In these 46 (82.14%) were male patients and 10 (17.86%) were females. In the adult population having age above 40 years, the most frequent entity was membranoproliferative GN 11(19.64%) cases followed by membranous GN 9(16.07%) cases and tubulointerstial nephritis 8(14.28%) cases. It is noted that nephrotic range proteinuria is most prevalent in membranous GN followed by focal segmental glomerulosclerosis. While nonnephrotic range proteinuria is mostly seen in membranoproliferative GN. It is also noticed that crescentic GN (100%) is invariably associated with deranged renal function followed in frequency by renal amyloidosis (60%) and acute tubular necrosis (40%). Conclusion: We conclude that in the adult population membranoproliferative GN is the leading histopathological entity in middle aged population followed by membranous GN in our population. Percutanous renal biopsy is a safe procedure. It helps us to determine the underlying histopathology for accurate diagnosis and guiding physicians in the management of such cases.

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