CHAPTER 1 Overview Of Renal Biopsy In Malaysia Lee Ming Lee Lily Mushahar Lee Day Guat
Table 1. 2. 1: Total number of renal biopsies by centres, 2005 – 2012 5 th MRRB report 2011 & 2012, Malaysia
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Table 1. 2. 2: Distribution of reported native and graft renal biopsies by centre, 2005 -2012 5 th MRRB report 2011 & 2012, Malaysia
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Table 1. 2. 3(a): Distribution of native renal biopsy in patients by number of episodes, 2005 -2012 Native 2005 - 2010 2011 2012 Total n % n % n 1 st episode 4711 86. 8 1214 84. 5 1219 85. 0 7144 2 nd episode 577 10. 6 174 12. 1 162 11. 3 913 3 rd episode 119 2. 2 37 2. 6 41 2. 9 197 ≥ 4 th episode 21 0. 4 11 0. 8 12 0. 8 44 Total Patient 5428 100 1436 100 1434 100 8298 5 th MRRB report 2011 & 2012, Malaysia
Table 1. 2. 3(b): Distribution of renal allograft biopsy in patients by number of episodes, 2005 -2012 Graft 2005 - 2010 2011 2012 Total n % n % n 1 st episode 344 58. 6 71 46. 7 96 49. 7 511 2 nd episode 148 25. 2 46 30. 3 53 27. 5 247 3 rd episode 55 9. 4 10 6. 6 20 10. 4 85 ≥ 4 th episode 40 6. 8 25 16. 4 24 12. 4 89 Total Patient 587 100 152 100 193 100 932 5 th MRRB report 2011 & 2012, Malaysia
Table 1. 2. 4. 1(a): Age distribution of native renal biopsy, 2005 -2012 Age group (years) 2005 - 2010 2011 2012 Total n n % <15 879 184 158 1221 14. 1 15 -<25 1589 404 391 2384 27. 5 25 -<35 1266 373 341 1980 22. 9 35 -<45 892 205 234 1331 15. 4 45 -<55 627 180 192 999 11. 5 55 -<65 292 100 109 501 5. 8 ≥ 65 147 48 46 241 2. 8 Total 5692 1494 1471 8657 100 5 th MRRB report 2011 & 2012, Malaysia
Table 1. 2. 4. 1(b): Age distribution of renal allograft biopsy, 2005 -2012 Age group (years) 2005 - 2010 2011 2012 Total n n % <15 37 9 8 54 4. 2 15 -<24 122 34 21 177 13. 7 25 -<35 133 36 78 247 19. 1 35 -<45 218 86 76 380 29. 3 45 -<55 176 44 69 289 22. 3 55 -<65 65 29 33 127 9. 8 65 15 1 5 21 1. 6 Total 766 239 290 1295 100 5 th MRRB report 2011 & 2012, Malaysia
Table 1. 2. 4. 1(c): Age group distribution of reported renal biopsies by state, 2005 -2012 5 th MRRB report 2011 & 2012, Malaysia
Table 1. 2. 4. 2(a): Gender distribution of native renal biopsy, 2005 -2012 2005 – 2010 2011 2012 n n % Male 2176 589 599 3364 40. 5 Female 3252 847 835 4934 59. 5 Total 5428 1436 1434 8298 100 Gender Total 5 th MRRB report 2011 & 2012, Malaysia
Table 1. 2. 4. 2(b): Gender distribution of renal allograft biopsy, 2005 -2012 2005 - 2010 2011 2012 n n % Male 370 101 121 592 63. 5 Female 217 51 72 340 36. 5 Total 587 152 193 932 100 Gender Total 5 th MRRB report 2011 & 2012, Malaysia
Table 1. 2. 4. 3(a): Racial distribution of native renal biopsy, 2005 -2012 2005 - 2010 2011 2012 n n % Malay 3110 862 851 4823 58. 1 Chinese 1390 320 346 2056 24. 8 Indian 359 109 98 566 6. 8 Others 569 145 139 853 10. 3 Total 5428 1436 1434 8298 100 Race Total 5 th MRRB report 2011 & 2012, Malaysia
Table 1. 2. 4. 3(b): Racial distribution of renal allograft biopsy, 2005 -2012 2005 - 2010 2011 2012 n n % Malay 186 49 59 294 31. 5 Chinese 314 80 97 491 52. 7 Indian 56 12 24 92 9. 9 Others 31 11 13 55 5. 9 Total 587 152 193 932 100 Race Total 5 th MRRB report 2011 & 2012, Malaysia
Table 1. 2. 5: Number of glomeruli obtained at each biopsy by centres, 2005 -2012 5 th MRRB report 2011 & 2012, Malaysia
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Table 1. 2. 6: Distribution of biopsy specimens to histopathology laboratories by participating centres, 2005 -2012 Centre 180 481 580 881 980 1080 1180 1280 1380 2081 4380 4381 20080 20180 20280 61280 62380 Total 2005 - 2010 n % 669 73. 4 368 71. 5 73 62. 4 168 49. 6 54 50. 9 44 78. 6 137 72. 1 456 75. 1 12 100 60 47. 2 77 51. 7 248 75. 2 89 21. 5 21 29. 6 0 0 394 49. 9 20 57. 1 18 72 172 89. 1 3080 60 Local histopathology laboratories 2011 2012 n % 136 14. 9 107 11. 7 78 15. 1 69 13. 4 22 18. 8 89 26. 3 82 24. 2 13 12. 3 39 36. 8 8 14. 3 4 7. 1 33 17. 4 20 10. 5 88 14. 5 63 10. 4 0 0 39 30. 7 28 22 51 34. 2 21 14. 1 41 12. 4 159 38. 5 165 40 24 33. 8 26 36. 6 75 50. 3 74 49. 7 168 21. 3 227 28. 8 13 37. 1 2 5. 7 7 28 0 0 21 10. 9 0 0 1065 20. 7 990 19. 3 Total n 912 515 117 339 106 56 190 607 12 127 149 330 413 71 149 789 35 25 193 5135 % 100 100 100 100 100 5 th MRRB report 2011 & 2012, Malaysia
Continue; Centre 180 380 481 580 780 881 980 1080 1181 1280 1380 1480 1780 2081 2380 4381 7781 2005 - 2010 n % 103 98. 1 319 60. 6 99 100 34 100 9 90 302 67. 6 98 60. 1 5 100 130 58. 6 9 100 1 50 78 83. 9 142 96. 6 516 73. 5 29 96. 7 28 22. 8 699 100 98 100 192 78 Outside histopathology laboratories 2011 2012 Total n % n % 1 1 105 100 96 18. 3 111 21. 1 526 100 0 0 99 100 0 0 34 100 0 0 1 10 10 100 80 17. 9 65 14. 5 447 100 36 22. 1 29 17. 8 163 100 0 0 5 100 0 0 0 0 1 100 44 19. 8 48 21. 6 222 100 0 0 9 100 1 50 0 0 2 100 0 0 15 16. 1 93 100 3 2 2 1. 4 147 100 81 11. 5 105 15 702 100 1 3. 3 0 0 30 100 40 32. 5 55 44. 7 123 100 0 0 699 100 0 0 98 100 30 12. 2 24 9. 8 246 100 All n 1017 526 614 151 349 447 269 61 191 608 234 9 129 242 147 702 360 123 1112 169 246 % 10. 2 5. 3 6. 2 1. 5 3. 5 4. 5 2. 7 0. 6 1. 9 6. 1 2. 4 0. 1 1. 3 2. 4 1. 5 7. 1 3. 6 1. 2 1. 7 2. 5 5 th MRRB report 2011 & 2012, Malaysia
Continue; Centre 20080 20180 20280 25280 60680 60980 61080 61280 61880 62380 62480 62580 65780 65880 68580 106881 108180 121580 126080 127780 Total 2005 - 2010 n % 0 0 4 9. 1 0 0 14 70 5 100 18 51. 4 39 59. 1 8 33. 3 5 100 6 100 0 0 6 85. 7 4 100 36 69. 2 44 71 39 69. 6 162 52. 6 14 77. 8 63 25 18 60 3378 70. 1 Outside histopathology laboratories 2011 2012 Total n % n % 1 100 0 0 1 100 15 34. 1 25 56. 8 44 100 2 100 0 0 2 100 3 15 20 100 0 0 5 100 7 20 10 28. 6 35 100 14 21. 2 13 19. 7 66 100 4 16. 7 12 50 24 100 0 0 5 100 0 0 6 100 18 31 40 69 58 100 0 0 1 14. 3 7 100 0 0 4 100 7 13. 5 9 17. 3 52 100 8 12. 9 10 16. 1 62 100 9 16. 1 8 14. 3 56 100 76 24. 7 70 22. 7 308 100 4 22. 2 0 0 18 100 82 32. 5 107 42. 5 252 100 5 16. 7 7 23. 3 30 100 668 13. 9 771 16 4817 100 All n 150 833 37 20 5 35 66 49 5 199 58 7 4 52 62 56 308 18 252 30 9952 % 1. 5 8. 4 0. 2 0. 1 0. 4 0. 7 0. 5 0. 1 2 0. 6 0. 1 0 0. 5 0. 6 3. 1 0. 2 2. 5 0. 3 100 5 th MRRB report 2011 & 2012, Malaysia
Figure 1. 2. 6(b) i: Distribution of biopsy specimens to Local histopathology laboratories by participating centres, 2005 -2012 5 th MRRB report 2011 & 2012, Malaysia
Figure 1. 2. 6(b) ii: Distribution of biopsy specimens to Outside histopathology laboratories by participating centres, 2005 -2012 5 th MRRB report 2011 & 2012, Malaysia
Table 1. 2. 6(c): Summary of biopsies received by local and outside laboratories, 2007 -2010 2007 2008 (1 st report) (2 nd report) 2009 (3 rd report) 2010 (4 th report) 2012 (5 th report) n % n % n % In house Lab 1085 44. 9 1799 47. 6 2360 48. 5 2984 47. 8 5135 51. 6 Outside Lab 1334 55. 1 1978 52. 4 2506 51. 5 3265 52. 2 4817 48. 40 All Lab 2419 100 3777 100 4866 100 6249 100 9952 100 5 th MRRB report 2011 & 2012, Malaysia
Table 1. 2. 6(d): Histopathology laboratories receiving renal biopsy specimens, 2005 -2012 5 th MRRB report 2011 & 2012, Malaysia
Table 1. 3. 1(a): Indications for native renal biopsies, 2005 -2012 Clinical Presentations 2005 - 2010 2011 2012 Total n % n % Asymptomatic urine abnormality 1624 28. 5 409 27. 4 443 30. 1 2476 28. 6 Nephritic syndrome 480 8. 4 124 8. 3 96 6. 5 700 8. 1 Nephrotic syndrome 2492 43. 8 558 37. 3 490 33. 3 3540 40. 9 Nephrotic-Nephritic syndrome 505 8. 9 187 12. 5 136 9. 2 828 9. 6 Not available/Missing 591 10. 4 216 14. 5 306 20. 8 1113 12. 9 Total 5692 100 1494 100 1471 100 8657 100 5 th MRRB report 2011 & 2012, Malaysia
Table 1. 3. 1(b): Renal function at time of biopsy, 2005 -2012 Clinical Presentations 2005 – 2010 2011 2012 Total n % n % Normal 2936 51. 6 729 48. 8 670 45. 5 4335 50. 1 Impaired 2106 37. 0 551 36. 9 541 36. 8 3198 36. 9 Not available/Missing 650 11. 4 214 14. 3 260 17. 7 1124 13. 0 Total 5692 100 1494 100 1471 100 8657 100 5 th MRRB report 2011 & 2012, Malaysia
Table 1. 3. 2: Histopathology of all native renal biopsies, 2005 -2012 5 th MRRB report 2011 & 2012, Malaysia
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Table 1. 3. 3. 1: HPE diagnosis in patients presenting with Nephrotic Syndrome, 2005 -2012 Type Primary GN Secondary GN Histopathological Diagnosis Minimal Change FSGS lg A nephropathy Membranous nephropathy Membrano-proliferative Mesangial Proliferative GN-non Ig. A Crescentic Idiopathic crescentic Not available/Missing Sub total Other infection Lupus Nephritis Henoch Schonlein Purpura HUS/TTP Amyloidosis Systemic vasculitis Post infection GN Polyarteritis nodosa Malignancy Light/ heavy chain disease Diabetic nephropathy Anti GBM Immunotactoid / fibrillary GN Multiple myeloma Not available/Missing Sub total Others Total *Patients may have either one or more histopathology or not have any histopathology Others = Tubulo. Disease + Vascular + Advance GN + Others + Hereditary (no observation) n 969 751 182 207 33 51 0 8 7 2208 9 815 4 1 12 1 29 0 1 1 181 0 0 1 10 1065 327 3600 % 26. 9 20. 9 5. 1 5. 8 0. 9 1. 4 0. 0 0. 2 61. 3 0. 3 22. 6 0. 1 0. 0 0. 3 0. 0 0. 8 0. 0 5. 0 0. 3 29. 6 9. 1 100. 0 5 th MRRB report 2011 & 2012, Malaysia
Table 1. 3. 3. 2: HPE diagnosis in Patients presenting with Asymptomatic Urine Abnormalities, 2005 -2012 Type Primary GN Secondary GN Histopathological Diagnosis Minimal Change FSGS lg A nephropathy Membranous nephropathy Membrano-proliferative Mesangial Proliferative GN-non Ig. A Crescentic Idiopathic crescentic Not available/Missing Sub total Other infection Lupus Nephritis Henoch Schonlein Purpura HUS/TTP Amyloidosis Systemic vasculitis Post infection GN Polyarteritis nodosa Malignancy Light/ heavy chain disease Diabetic nephropathy Anti GBM Immunotactoid / fibrillary GN Multiple myeloma Missing Sub total Others Total * Patients may have either one or more histopathology or not have any histopathology Others = Tubulo. Disease + Vascular + Advance GN + Others + Hereditary n 151 232 376 66 8 42 8 13 6 902 3 1031 22 0 8 5 24 0 0 1 90 0 0 7 5 1196 321 2419 % 6. 2 9. 6 15. 5 2. 7 0. 3 1. 7 0. 3 0. 5 0. 2 37. 3 0. 1 42. 6 0. 9 0. 0 0. 3 0. 2 1. 0 0. 0 3. 7 0. 0 0. 3 0. 2 49. 4 13. 3 100. 0 5 th MRRB report 2011 & 2012, Malaysia
Table 1. 3. 3. 3: HPE diagnosis in patients presenting with Nephritic. Nephrotic, 2005 -2012 Type Primary GN Secondary GN Histopathological Diagnosis Minimal Change FSGS lg A nephropathy Membranous nephropathy Membrano-proliferative Mesangial Proliferative GN-non Ig. A Crescentic Idiopathic cresentic Not available/Missing Sub total Other infection Lupus Nephritis Henoch Schonlein Purpura HUS/TTP Amyloidosis Systemic vasculitis Post infection GN Polyarteritis nodosa Malignancy Light/ heavy chain disease Diabetic nephropathy Anti GBM Immunotactoid / fibrillary GN Multiple myeloma Not available/Missing Sub total Others Total * Patients may have either one or more histopathology or not have any histopathology Others = Tubulo. Disease + Vascular + Advance GN + Others + Hereditary (no observation) n 49 62 78 13 11 15 2 8 1 239 5 427 8 1 0 2 44 0 24 0 0 1 2 516 108 863 % 5. 7 7. 2 9. 0 1. 5 1. 3 1. 7 0. 2 0. 9 0. 1 27. 7 0. 6 49. 5 0. 9 0. 1 0. 0 0. 2 5. 1 0. 0 0. 2 0. 0 2. 8 0. 0 0. 1 0. 2 59. 8 12. 5 100. 0 5 th MRRB report 2011 & 2012, Malaysia
Table 1. 3. 3. 4: HPE diagnosis in Patients presenting with Nephritic syndrome, 2005 -2012 Type Primary GN Secondary GN Histopathological Diagnosis Minimal Change FSGS lg A nephropathy Membranous nephropathy Membrano-proliferative Mesangial Proliferative GN-non Ig. A Crescentic Idiopathic cresentic Not available/Missing Sub total Other infection Lupus Nephritis Henoch Schonlein Purpura HUS/TTP Amyloidosis Systemic vasculitis Post infectious GN Polyarteritis nodosa Malignancy Light/ heavy chain disease Diabetic nephropathy Anti GBM Immunotactoid / fibrillary GN Multiple myeloma Not available/Missing Sub total Others Total * Patients may have either one or more histopathology or not have any histopathology Others = Tubulo. Disease + Vascular + Advance GN + Others + Hereditary n 43 55 64 4 12 14 7 13 5 217 0 288 7 0 1 7 53 0 0 0 22 1 0 0 1 380 102 699 % 6. 2 7. 9 9. 2 0. 6 1. 7 2. 0 1. 9 0. 7 31. 0 0. 0 41. 2 1. 0 0. 1 1. 0 7. 6 0. 0 3. 1 0. 0 0. 1 54. 4 14. 6 100 5 th MRRB report 2011 & 2012, Malaysia
Table 1. 3. 3. 5: Table for Primary Glomerulonephritis, 2005 -2012 5 th MRRB report 2011 & 2012, Malaysia
Figure 1. 3. 3. 5: Primary gromerulonephritis according to the various age group, 2005 -2012 Minimal change disease Ig A Nephropathy Membrano proliferative Crescentic ANCA Not available/Missing FSGS Membranous nephropathy Mesangial proliferative Non-Ig A Idiopathic crescentic 100% 90% 80% Percentage (%) 70% 60% 50% 40% 30% 20% 10% 0% <15 15 -<25 25 -<35 35 -<45 Age 45 -<55 55 -<65 >65 5 th MRRB report 2011 & 2012, Malaysia
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