Perfil epidemiológico das doenças glomerulares em um ambulatório terciário durante vinte e cinco anos: novos e velhos problemas

Abstract

Glomerular diseases (GD) represent an important etiology of chronic kidney disease (CKD) and are associated with high rates of morbidity and mortality. The objective of the study was to carry out sociodemographic and clinical characterization of patients with GD, whether or not they underwent renal biopsy, treated at the Nephrology service of the Federal University of Juiz de Fora. A retrospective cohort study was carried out analyzing the medical records of patients treated between January 1998 and January 2023. Sociodemographic, clinical, histopathological and outcome variables were analyzed. Comparative analysis between primary glomerular disease (PGD) versus secondary glomerular disease (SGD) and by histopathological type (9 subgroups). Regression analysis with renal survival as the outcome variable. In the sample of 417 patients, 57.3% were women, 69.8% were white, mean age was 41.7  14.4 years, 51.1% were classified as PGD and 77.5% underwent renal biopsy. The most frequent histopathological diagnosis was lupus nephritis (LN, 25.1%), followed by segmental and focal glomerulosclerosis (16.1%), IgA nephropathy (15.8%). The most common comorbidity was hypertension (78.2%), followed by dyslipidemia (47.2%) and psychiatric illness (39.6%). High percentage of current or previous smoking (29.7%). The main nephrological clinical presentation was nephrotic syndrome (33.8%); 15.5% had initial acute kidney injury. Family history of nephropathies present in 23.3%. Use of antiproteinurics in 89.2% and 60.7% were immunosuppressed. Initially, lower levels of hemoglobin (p < 0.0001) and platelets (p = 0.026) were found in the SGD; and lower albumin levels (p = 0.011) and higher cholesterol levels (p < 0.0001) in primary cases. A higher proportion of patients with SGD underwent more than one renal biopsy (14.5%, p = 0.006). Regarding outcome, the mean initial estimated glomerular filtration rate (eGFR) was 72.9  33.3 and final 62.5  33.3 (p < 0,0001), median initial proteinuria was 2.3 (0.9-5. 3) and final of 0.5 (0.1-1.6) (p < 0,0001). Most patients were active in the outpatient clinic (61.4%), with low rates of dialysis (4.6%) and death (1.2%). Better renal survival curves in patients with minimal change disease and worse in those with membranoproliferative glomerulonephritis (MPGN) (p = 0.001). Regarding CKD progression, the main protective variables were: better initial eGFR (Relative Risk [RR] = 0.954, 95% CI: 0.929-0.978; p = 0.001) and absent interstitial fibrosis (RR = 0.334, 95% CI: 0.121-0.923; p = 0.035); those at risk: higher body mass index (RR = 1.155, 95% CI: 1.029-1.297; p = 0.015) and immunosuppressive treatment (RR = 3.819, 95% CI: 1.088-13.411; p = 0.037). Over time, there was an increase in cases of LN, and a reduction in podocytopathies and membranous nephropathy. Knowing the epidemiological profile of GD is essential for planning policies to better assist this specific group of patients. p = 0,015) e tratamento imunossupressor (RR = 3,819, IC 95%: 1,088-13,411; p = 0,037). Na evolução tempo, houve aumento dos casos de NL, e redução de podocitopatias e nefropatia membranosa. Conhecer o perfil epidemiológico das DG é fundamental para o planejamento de políticas para melhor assistência desse grupo específico de pacientes