Pathological Evolution Of Renal Biopsies Of 5705 Cases In Shandong Province

Objective:Renal biopsy is one of the essential aids in determining the type of kidney disease pathology.With the environmental and dietary changes,the type of kidney pathology in China is changing continuously.The chief purpose of this study was to investigate renal composition in Qilu Hospital of Shandong University from 2004 to 2021 and compare it with other studies at home and abroad to evaluate the evolutionary trends of renal pathology distribution and disease pathology spectrum in Shandong.Methods:Data were collected from 5705 patients who underwent percutaneous renal biopsy in Qilu Hospital of Shandong University from 2004-01-01 to 2021-12-31.It was divided into five age groups,namely ≤14 years old,15-24 years old,25-44 years old,45-59 years old and≥ 60 years old.Patients were divided into three periods according to the time of renal biopsy,namely period 1(2004-2009),period 2(2010-2015)and period 3(2016-2021).Results:In total,5705 cases of renal pathology were included,and males accounted for the majority(56.81%).5705 patients with renal biopsy ranged in age from 5 to 81 years old,and the mean age was 38.90±15.37 years old.The mean age of renal biopsy gradually increased over time.The number of kidney biopsies was found to be increasing year by year,and the rate of kidney biopsies in the aged over 60 increased from 2.42%to 16.14%.Renal diseases consisted of primary glomerular disease(PGN)(77.90%),secondary glomerular disease(SGN)(19.68%),tubulointerstitial disease(TIN)(1.79%)and hereditary glomerular disease(HERN)(0.63%).Membranous nephropathy(MN)(41.52%),IgA nephropathy(IgAN)(25.99%),minimal change nephropathy(MCD)(12.83%),and focal segmental glomerulosclerosis(FSGS)(7.34%)were the main components of PGN.Compared with period 1,the proportion of MN increased significantly in period 3,and the proportion of MN in the second stage exceeded IgAN and mesangial proliferative glomerulonephritis(MsPGN)to become the most common pathological type of PGN.While the proportion of MsPGN and IgAN showed a decreasing trend.Age subgroup analysis MN,IgAN and MCD were commoned in all age groups.MCD was mainly concentrated in the age group below 25 years old,and the most common pathological type in the age group above 25 years was MN,and the proportion of MN keeps increasing with age.The proportion of IgAN in the age group over 45 years decreased with age.Gender analysis of PGN showed no significant difference in pathological types except Clq nephropathy and IgM nephropathy.The most common pathological types of SGN were lupus nephritis(LN)(36.78%),diabetic nephropathy(DN)(14.51%),hepatitis B virus associated nephritis(HBVN)(13.71%),hypertensive renal damage(HT)(12.11%),and henoch-schonlein purpura nephritis(HSPN)(11.75%).The proportions of HSPN(3 periods were 21.33%,13.39%and 7.32%)and HBVN(22.27%,15.77%,9.41%in 3 periods)showed a decreasing trend(P<0.001),and HT(9.00%,14.58%,11.85%in 3 periods,P=0.335)and LN(constituent ratio 36.02%,36.61%,37.28%,P=0.091)had no change significantly,and lupus nephritis mostly occurred in young people aged 25-44 year.With increasing age,the composition ratios of metabolic diseases such as DN(6.64%,11.01%,and 19.51%in the 3 periods)and Renal amyloidosis(AMY)(2.84%,5.36%,and 7.14%in the 3 periods)in the third stage increased 2-fold compared with the first stage.Gender analysis of SGN showed that HBVN,HSPN,DN,HT and Obesity-related kidney damage were more common in males,while lupus nephritis was the dominant disease in females,and the gender differences of the above diseases were statistically significant.The most common pathological types of PGN in the elderly population were MN,IgAN,MCD and FSGS.Respectively,MN accounts for 68.35%of PGN.While AMY,DN and HT were common in the elderly SGN.Conclusion:1.This study retrospectively analyzed the renal pathological data of 5705 cases from Qilu Hospital of Shandong University,and only observed the pathological spectrum of renal biopsy.The patients were basically from all regions of Shandong Province,which was geographically representative.Renal diseases are more common in males in Shandong province,accounting for 56.81%of the total kidney diseases.In this region,kidney diseases mainly occur in young and middle age,and the average age of kidney biopsies is increasing.2.Primary glomerular disease is the most common cause of kidney disease,followed by secondary glomerular disease,and hereditary glomerular disease is rare.3.Membranous nephropathy in PGN overtook IgAN and MsPGN as the most common pathological type of primary glomerular disease in period 2(2010-2015),the composition ratio of IgAN and MsPGN decreased.Analysis of the age subgroups revealed that the proportion of MN in the age group above 25 increased with age.4.LN is the most common pathological type of SGN,and the composition ratio of LN does not change significantly in the three periods,and it is more common in women aged 25-44 years.DN,HT and AMY increase continuously,while HBVN and HSPN decrease over time.5.The number of elderly people who receive pathological kidney biopsies is increasing.The most common pathological types of PGN in the aged group are MN,IgAN,MCD and FSGS;The most common types of SGN are AMY,DN and HT.