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EDITORIAL COMMENTARY
Year : 2022  |  Volume : 68  |  Issue : 2  |  Page : 68-69

Glomerulonephritis registry: Need of the hour


Department of Nephrology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India

Date of Submission21-Sep-2021
Date of Decision30-Sep-2021
Date of Acceptance04-Oct-2021
Date of Web Publication30-Mar-2022

Correspondence Address:
T Jamale
Department of Nephrology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpgm.JPGM_343_21

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How to cite this article:
Jamale T. Glomerulonephritis registry: Need of the hour. J Postgrad Med 2022;68:68-9

How to cite this URL:
Jamale T. Glomerulonephritis registry: Need of the hour. J Postgrad Med [serial online] 2022 [cited 2022 May 23];68:68-9. Available from: https://www.jpgmonline.com/text.asp?2022/68/2/68/341381




Glomerulonephritis (GN) is one of the most common causes of end-stage renal disease (ESRD) globally, and arguably, may be the leading cause in some of the developing countries where diabetes is fast catching up.[1],[2] With prompt diagnosis and appropriate management, progression to renal failure can be slowed down in most and completely avoided in some of these patients. Data from large, multicenter trials to guide management of GN is limited, although this picture may be changing fast.[3]

Longitudinal follow-up of these patients in dedicated GN clinics can potentially facilitate monitoring of disease trajectories, and thereby their management. In this issue of the journal, Atlani et al.[4] have reported their initial experience of setting up of a dedicated GN clinic. In a cohort of 78 patients, over about 20 months of follow-up, 10 patients suffered either significant decline in renal function or ESRD. About 30% of the patients were categorized as “therapy resistant,” while others achieved either complete or partial response. Focal segmental glomerulosclerosis (FSGS) and IgA nephropathy fared the worst. Results of this study are consistent with the observed presentation and course of these diseases in India. IgA nephropathy, which is the most common cause of GN worldwide, is classically thought to have a benign course. However, many reports have highlighted the “malignant course” of this disease in South East Asia.[5] This may have to do with the genetic differences, late presentation, association with severe hypertension, and lead time bias. FSGS is known to be resistant to the initial therapy in about one-third of the patients, which was also observed in the present study. FSGS is increasingly understood as a “pattern of glomerular injury” in response to various etiologies rather than a disease by itself. Clinical, imaging, electron microscopic, and genetic evaluation can help identify early those patients who would not be benefited by (and therefore spared from the harm of) immunosuppression.[6]

Irrespective of the etiology, aggressive nonimmunosuppressive measures to control proteinuria and hypertension are the cornerstone of management of these patients.[7] Dedicated remission clinics have previously reported excellent long-term outcomes with this approach. Ruggenenti et al.[8] have reported that during a median follow-up of 4 years, the monthly rate of glomerular filtration rate (GFR) decline was significantly lower in their remission clinic cohort (median − 0.17 versus − 0.56 mL/min per 1.73 m2; P < 0.0001) and ESRD events were significantly reduced (3.6% versus 30.4% reached ESRD). Similarly, Mani et al.[9] have reported use of high-dose dual renin angiotensin system (RAS) blockade in Indian population to prevent chronic kidney disease. These approaches also involved the use of “controversial” dual RAS blockade and demonstrated its safety and efficacy. As data on possible harm of dual blockade is mainly derived from diabetes trials, and given the initial encouraging results, large-scale evaluation of this strategy in GN is urgently needed.

Racial differences in the presentation, natural course, and response to the therapy of these diseases[10],[11] make strong case for country-specific multicenter collaboration to establish GN registries, which can immensely contribute to the understanding of the natural history, treatment strategies, and prognosis of GN.



 
 :: References Top

1.
Rajapurkar MM, John GT, Kirpalani AL, Abraham G, Agarwal SK, Almeida AF, et al. What do we know about chronic kidney disease in India: First report of the Indian CKD registry. BMC Nephrol 2012;13:10.  Back to cited text no. 1
    
2.
Kulkarni MJ, Jamale T, Hase NK, Jagdish PK, Keskar V, Patil H, et al. A cross-sectional study of dialysis practice-patterns in patients with chronic kidney disease on maintenance hemodialysis. Saudi J Kidney Dis Transpl 2015;26:1050-6.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Cattran DC, Feehally J, Cook HT, Liu ZH, Fervenza FC, Mezzano SA, et al. Kidney disease: Improving global outcomes (KDIGO) glomerulonephritis work group. KDIGO clinical practice guideline for glomerulonephritis. Kidney Int Suppl 2012;2:139-274.  Back to cited text no. 3
    
4.
Atlani M, Kapoor NK, Joshi D, Sutar R, Sharma T, Joshi A. Short term outcome of patients attending a renal-immunology clinic in central India. J Postgrad Med 2022;68:78-84.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Chacko B. IgA nephropathy in India: What we do know. Ren Fail 2011;33:102-7.  Back to cited text no. 5
    
6.
De Vriese AS, Sethi S, Nath KA, Glassock RJ, Fervenza FC. Differentiating primary, genetic, and secondary FSGS in adults: A clinicopathologic approach. J Am Soc Nephrol 2018;29:759-74.  Back to cited text no. 6
    
7.
Remuzzi G, Ruggenenti P, Perico N. Chronic renal diseases: Renoprotective benefits of renin-angiotensin system inhibition. Ann Intern Med 2002;136:604-15.  Back to cited text no. 7
    
8.
Ruggenenti P, Perticucci E, Cravedi P, Gambara V, Costantini M, Sharma SK, et al. Role of remission clinics in the longitudinal treatment of CKD. J Am Soc Nephrol 2008;19:1213-24.  Back to cited text no. 8
    
9.
Limesh M, Annigeri RA, Mani MK, Kowdle PC, Rao BS, Balasubramanian S, et al. Retarding the progression of chronic kidney disease with renin angiotensin system blockade. Indian J Nephrol 2012;22:108-15.  Back to cited text no. 9
  [Full text]  
10.
Yeo SC, Goh SM, Barratt J. Is immunoglobulin A nephropathy different in different ethnic populations? Nephrology (Carlton) 2019;24:885-95.  Back to cited text no. 10
    
11.
Korbet SM, Schwartz MM, Evans J, Lewis EJ; Collaborative Study Group. Severe lupus nephritis: Racial differences in presentation and outcome. J Am Soc Nephrol 2007;18:244-54.  Back to cited text no. 11
    




 

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