Background: Nephropathy is a major cause of end stage kidney failure patients caused by glomerular and non glomerular diseases. The study aimed at assessing the description of nephropathy after nephrectomy by the age, gender, clinical syndrome, cause, urinalysis findings, and histopathology findings. Materials and Methods: We reviewed medical records of nephropathy after nephrectomy patients by age, gender, clinical syndrome, cause, urinalysis findings, and histopathology findings in Arifin Achmad Regional General Hospital, Pekanbaru, Riau Province, Indonesia in January 2011 - Desember 2017. Statistical analysis of univariate was used. Approval on the study was obtained from the Ethical Review Board for Medicine and Health Research, Medical Faculty, University of Riau. Results:There were 58 patients in this study. The result showed that nephropathy after nephrectomy patients were mostly (58.6%) in 40-59 year old age group and most frequent (53.4%) in males. The most frequent (48.3%) clinical syndromes were chronic glomerulonephritis. The most (63.8%) causes were non-glomerular diseases. Most frequent urinalysis findings were microscopic haematuria in 39.7% patients and proteinuria (+2) in 31.7% patients. The most frequent histopathologic finding was interstitial fibrosis in 66.7% patients. Conclusions: Microscopic haematuria and proteinuria (+2) were the most frequent urinalysis findings while interstitial fibrosis was the most frequent histopathology findings in nephropathy patients.
Nephropathy is an inflammatory process in the glomeruli with aetiology, pathogenesis and pathophysiology, various histopathological changes in the kidneys but with almost uniform clinical features[
Clinical epidemiological studies had shown that nephropathy was a major cause of terminal kidney failure patients [
Grogan (2010) studied glomerulonephritis or primary nephropathy found in adult cases with the highest incidence rates of IgA 2.
Nephropathy occurs due to glomerular damage with various pathogenesis both in primary and secondary or due to changes in anatomical structure and decreased kidney physiology caused by disturbances in other urological organs such as the presence of blockage of the urinary tract. Clinical features of nephropathy might occur without complaints and discovered incidentally from routine urine examinations, mild complaints to medical emergencies requiring kidney replacement therapy [
Clinical manifestations might occur in asymptomatic urinary abnormalities, macroscopic haematuria, nephritic syndrome, nephritic syndrome, rapidly progressive glomerulonephritis and chronic glomerulonephritis [
Based on the above description, we aimed to conduct a study on the hematuria and proteinuria of urinalisis findings in nephropathy before nephrectomy in Arifin Achmad Regional General Hospital, Pekanbaru, Riau Province, Indonesia.
We reviewed medical records of nephropathy after nephrectomy patients by age, gender, clinical syndrome, cause, urinalysis findings, and histopathology findings in Arifin Achmad Regional General Hospital, Pekanbaru, Riau Province, Indonesia in January 2011 – Desember 2017. Statistical analysis of univariate was used. Approval on the study was obtained from the Ethical Review Board for Medicine and Health Research, Medical Faculty, University of Riau.
In this study there were 58 patients with nephropathies disease underwent nephrectomies
Table 1. Age and gender frequency distributions of nephropathy patients underwent nephrectomies
6%) patients, and the lowest was in 0-19 year old age group in 2 people (34%) Male (534%) was more frequent than female (466%)
Age (year) | Gender | Frequency N | Percentage (%) | ||||
Male | Female | ||||||
N | (%) |
N |
(%) | ||||
0-19 | 1 | 1.7 | 1 | 1.7 | 2 | 3.4 | |
20-39 | 9 | 15.5 | 6 | 10.3 | 15 | 25.9 | |
40-59 | 17 | 29.3 | 17 | 29.3 | 34 | 5.6 | |
≥60 | 4 | 6.9 | 3 | 5.3 | 7 | 12.1 | |
Total | 31 | 53.4 | 27 | 46.6 | 58 | 100 |
Table 2. Clinical syndrome frequency distribution of nephropathy patients underwent nephrectomies
3%) patients while the least one was nephritic syndrome in 6 (103%) patients The age group 40-59 years was more common in women in 10 (172%) patients
Clinical syndrome | 0-19 | 20-39 | 40-59 | ≥60 | |||||||
(N)=2
|
(N)=15 (25.9%) | (N)=34 (5.,6%) | (N)=7
|
Total | |||||||
M | F | M | F | M | F | M | F | N | (%) | ||
Chronic glomerulo-
|
- | - | 6 | 2 | 6 | 10 | 2 | 2 | 28 | 48.3 | |
Nephrotic syndrome | 1 | - | - | 1 | 3 | 4 | - | 1 | 10 | 17.2 | |
Macros-copic hematuria | - | 1 | - | 1 | 3 | 2 | - | - | 7 | 12.1 | |
Rapidly progressive glomerulo
|
- | - | 2 | 1 | 3 | - | 1 | - | 7 | 12.1 | |
Nephritic syndrome | - | - | 1 | 1 | 2 | 1 | 1 | - | 6 | 10.3 | |
58 | 100 |
Table 3. The cause frequency distribution of nephropathy patients underwent nephrectomies
8%) patients in the age of 40-59 years and more frequently in males in 12 (207%) and the least cause was glomerular disease in 21 (362%) patients in which also often in the age of 40-59 years and occurred in women 7 (12%) patients
Causes of nephropathy |
0-19 | 20-39 | 40-59 | ≥60 | Total | ||||||
N=2
|
N=15 (25.9%) | N=34 (5.6%) | N=7
|
||||||||
M | F | M |
F |
M |
F | M | F | (N) | (%) | ||
Glomerular |
1 |
- | 6 | 1 | 5 | 7 | - | 1 | 21 | 36.2 | |
lNon glomerular |
|
1 |
2 |
6 | 12 | 10 | 4 | 2 | 37 | 63.8 | |
58 |
100100 |
Table 4. Hematuria finding frequency distribution of nephropathy patients before underwent nephrectomies
7%) patients, in the age group 40-59 years and in men in 8 (138%) while the macroscopic hematuria was in 22 (379%) patients
Hematuria finding | 0-19 | 20-39 | 40-59 | ≥60 | |||||||
(N)=2
|
(N)=15 (25.9%) | (N)=34 (58.6%) | (N)=7
|
Total | |||||||
M | F | M | F | M | F | M | F | (N) | (%) | ||
Negative | 1 | - | 2 | 1 | 2 | 6 | - | 1 | 13 | 22.4 | |
Micro
|
- | 1 | 3 | 4 | 8 | 5 | 1 | 1 | 23 | 39.7 | |
Macro
|
- | - | 3 | 2 | 7 | 6 | 3 | 1 | 22 | 37.9 | |
58 | 100 |
Table 5. Proteinuria finding frequency distribution of nephropathy patients before underwent nephrectomies
5%) patients, mostly in 40-59 year old age group and in male (12%) while the least proteinuria +4 was in 2 (34%) patients in 20-39 year old age group and in ≥60 year old age group in 1 (17%) patientsTable 6 The histopathology findings frequency distribution of nephropathy patients underwent nephrectomies
Proteinuria level | 0-19 | 20-39 | 40-59 | ≥60 | |||||||
(N)=2
|
(N)=15 (2.,9%) | (N)=34 (58.6%) | (N)=7
|
Total | |||||||
L | P | L | P | L | P | L | P | (N) | (%) | ||
Negative | - | 1 | - | - | 4 | 2 | - | - | 7 | 12.1 | |
(+1) | - | - | 2 | 1 | 4 | 4 | 2 | 1 | 14 | 24.1 | |
(+2) | - | - | 4 | 4 | 7 | 4 | 1 | - | 20 | 34.5 | |
(+3) | 1 | - | 2 | 1 | 2 | 7 | 1 | 1 | 15 | 25.9 | |
(+4) | - | - | 1 | - | - | - | - | 1 | 2 | 3.4 | |
58 | 100 |
7%) interstitial fibrosis and least (25%) was glomerulosclerosis
Histopathology | Frequency
|
Percentage (%) | |
Chronic inflammation | 21 | 36.2 | |
Glomerulosclerosis | 14 | 24.1 | |
Tubular atrophy | 34 | 58.6 | |
Interstitial fibrosis | 42 | 72.4 | |
Other | 9 | 15.5 |
This study result showed the most frequent patients was in 40-59 age year old group in 34 (58.6%) patients, and the least in the age group 0-19 years as many as 2 people (3.4%). Male patients were more (31.4%) than the female in 27 (46.6%). There were no gender-based differences in nephropathy after nephrectomy in the most age groups and in the least. The characteristics of patients by age in this study suited a study by Jain (2017) found the most nephropathy patients was in 25-50 year old age group in 32 (72.72%) patients [
Several literatures stated nephropathy diseases might occur in all age groups [
Characteristics of patients by gender in this study was similar other studies. O'Shaughnessy (20
The study result found the most common clinical syndrome in patients with nephropathy after nephrectomy was chronic glomerulonephritis in
The acute nephritic syndrome or glomerulonephritis has a proteinuria criteria of 150 mg-3 g daily, hematuria >
This study result showed that nephropathy patients were most commonly caused by non-glomerular diseases 37 (63.8%) patients, mostly in 40-59 year old age group and more often in males in
Non-glomerular causes of the study consisted of urinary tract stones, pelvic uretero junction obstruction (PUJO), specific infections of kidney tuberculosis and polycystic kidney disease. In this study result showed 28 cases of nephropathy after nephrectomies caused by urinary tract stones. Blockages by stones in the kidneys and urinary tract might cause impaired kidney function. Long-lasting blockages might result in urine back flow up (reflux), so the kidneys dilated (hydronephrosis) or dilatation of the urinary tract over the blockage, causing malfunction and damage to permanent renal structure. Urinary tract stones were commonly found in 30-50 year old age group and were more common in men [
This study results showed in nephropathy before nephrectomy, the most common were urinalysis finding was microscopic hematuria in 23 (39.7%) patients, mostly in 40-59 year old age group and often occurred in men 8 (13.8%) patients while macroscopic haematuria in 37.9% patients. A study by Yuste (
Microscopic haematuria is characterized by the discovery of three or more erythrocytes/HPF without known cause and is known only by microscopic urine examination. The causes might be associated to both urological and nephrology diseases [
Macroscopic haematuria is often caused by common urological causes including urinary tract infections, urinary tract stones or urological malignancies. In addition, microscopic and macroscopic haematurias might also be caused by partial obstruction of the urinary tract or may also be caused by other unilateral renal abnormalities that also cause erythrocytes in urine sediments. Therefore, the causes of haematuria should be known quickly to estimate the origin of urinary tract abnormalities in patients. Negative hematuria in nephropathy disease occurs due to changes in the membrane of glomerular filtration in the form of sclerosis or interstitial fibrosis that causes urine disturbed so that the absence of erythrocytes in the urine sediment or even anuria might occur [
This study showed positive protenuria +2 as was mostly in 20 (34.5%) patients, mostly occurred 40-59 year old age group and occurred in12% of men patients. The least was positive proteinuria +4 in 2 (3.4%) patients, occurred in 20-39 year old age group and ≥60 each in 1 (1.7%) patients. This study result suited a study by Kunitoshi (2011) showed that 450 end stage renal disease (ESRD) patients had proteinuria +2 in 16% patients and proteinuria +4 in less than 1 % [
This study result showed interstitial fibrosis were mostly 66.7% patients and at least was glomerulosclerosis in 25% patients. A study by Leal (2017) found the most common histopathologic features of patients with nephropathy were atrophy of the interstitial tubules and fibrosis in 78% patients [
Persistent glomerulonephritis that aggravates kidney function was always accompanied by interstitial nephritis, kidney fibrosis, and tubular atrophy. The flow of urine was inhibited by tubular obstruction as a result of interstitial inflammation and fibrosis. Interstitial changes, including interstitial edema or fibrosis, alter tubular and vascular morphology that might interfere the normal tubular transport. The soluble and water from the tubular lumen moves into the vascular space. In addition, vascular resistance affects renal function through two mechanisms. First, tubular cells are highly metabolically active, resulting in a decrease in renal perfusion leading to ischemic injury. Second, arterial glomerular outflow interference causes intra glomerular hypertension to increase intra glomerular exacerbations and prolong the mesangial sclerosis and glomerulosclerosis [
Microscopic haematuria and proteinuria (+2) were the most frequent urinalysis findings while interstitial fibrosis was the most frequent histopathology findings in nephropathy patients.Microscopic haematuria and proteinuria (+2) were the most frequent urinalysis findings while interstitial fibrosis was the most frequent histopathology findings in nephropathy patients.