CHAPTER 1 Overview of Renal Biopsy in Malaysia Wan Sha’ariah Md Yusuf Lee Ming Lee Lee Day Guat

CHAPTER 1Overview of Renal Biopsy in Malaysia

Wan Sha’ariah Md YusufLee Ming LeeLee Day Guat

Table 1.2.1: Total number of biopsy performed and percentage of reported renal biopsies by centres, 2005-2010

4th MRRB report 2010, Malaysia


Table 1.2.1: Total number of biopsy performed and percentage of reported renal biopsies by centres, 2005-2010 (con’t)

Table 1.2.1(b): Total number of reported and unreported renal biopsies, 2005-2010


Year 2005 2006 2007 2008 2009 2010 Total

Reported 720 937 977 1182 1134 1299 6249

Not reported 430 597 343 372 394 239 2375

Total performed 1150 1534 1320 1554 1528 1538 8624

Ascertainment rate (%) 62.6 61.1 74 76.1 74.2 84.5 72.1

Table 1.2.2: Distribution of reported native and graft renal biopsies by centre, 2005-2010



Table 1.2.2: Distribution of reported native and graft renal biopsies by centre, 2005-2010 (cont.)

Table 1.2.3(a): Distribution of native renal biopsy in patients by number of episodes, 2005-2010


Native

2005 2006 2007 2008 2009 2010 Total

n % n % n % n % n % n % n %

1st episode 559 87 704 87 731 87 919 88 847 86 941 86 4701 87

2nd episode 72 11 95 12 84 10 106 10 103 11 114 10 574 11

3rd episode 10 1.6 9 1.1 25 3 15 1.4 26 2.7 35 3.2 120 2.2

≥4th episode 1 0.2 0 0 3 0.4 3 0.3 6 0.6 7 0.6 20 0.4

Total Patient 642 100 808 100 843 100 1043 100 982 100109

7 100 5415 100

Table 1.2.3 (b): Distribution of renal allograft biopsy in patients by number of episodes/attempts, 2005-2010


Graft

2005 2006 2007 2008 2009 2010 Total

n % n % n % n % n % n % n %

1st episode 48 77.4 70 69.3 60 63.2 54 52.4 52 50 58 48 342 58.5

2nd episode 11 17.7 21 20.8 22 23.2 32 31.1 32 30.8 30 25 148 25.3

3rd episode 3 4.8 7 6.9 9 9.5 10 9.7 11 10.6 15 12.5 55 9.4

≥4th episode 0 0 3 3 4 4.2 7 6.8 9 8.7 17 14.2 40 6.8

Total Patient 62 100 101 100 95 100 103 100 104 100 120 100 585 100

Table 1.2.4.1(a): Age distribution of native renal biopsy, 2005-2010

Age group (years)

2005 2006 2007 2008 2009 2010 Total

n n n n n n n %

<15 128 137 145 165 137 157 869 15.8

15-<24 173 237 226 308 295 307 1546 28.1

25-<35 143 183 194 227 227 254 1228 22.3

35-<45 116 126 132 143 156 187 860 15.6

45-<55 59 82 91 135 99 125 591 10.7

55-<65 18 41 44 51 48 67 269 4.9

> 65 12 13 21 29 39 22 136 2.5

Total 649 819 853 1058 1001 1119 5499 100


Table 1.2.4.1(b): Age distribution of renal allograft biopsy, 2005-2010

Age group (years)

2005 2006 2007 2008 2009 2010 Total

n n n n n n n %

<15 0 5 7 9 8 8 37 4.9

15-<25 15 26 19 22 18 21 121 16.1

25-<35 11 25 15 20 30 29 130 17.3

35-<45 23 26 49 25 24 66 213 28.4

45-<55 12 24 24 35 36 40 171 22.8

55-<65 8 8 10 9 16 12 63 8.4

> 65 2 4 0 4 1 4 15 2.0

Total 71 118 124 124 133 180 750 100


Table 1.2.4.1(c): Age group distribution of reported renal biopsies by state, 2005-2010

Year of biopsy 2005 2006 2007

Age gp (years) Age < 15 Age ≥ 15 Age < 15 Age ≥ 15 Age < 15 Age ≥ 15

State n % n % n % n % n % n %

Johor 29 22.7 67 11.3 24 16.9 81 10.2 45 29.6 53 6.4

Kedah 0 0.0 2 0.3 0 0.0 10 1.3 4 2.6 21 2.5

Kelantan 2 1.6 13 2.2 0 0.0 23 2.9 2 1.3 28 3.4

Melaka 2 1.6 19 3.2 2 1.4 25 3.1 1 0.7 20 2.4

N.Sembilan 11 8.6 25 4.2 6 4.2 27 3.4 10 6.6 25 3.0

Pahang 0 0.0 0 0.0 6 4.2 38 4.8 5 3.3 6 0.7

Perak 3 2.3 29 4.9 2 1.4 38 4.8 0 0.0 49 5.9

Perlis 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Penang 14 10.9 96 16.2 18 12.7 104 13.1 19 12.5 67 8.1

Sabah 1 0.8 38 6.4 5 3.5 45 5.7 5 3.3 42 5.1

Sarawak 6 4.7 68 11.5 8 5.6 101 12.7 4 2.6 64 7.8

Selangor 17 13.3 121 20.4 29 20.4 181 22.8 17 11.2 161 19.5

Terengganu 2 1.6 15 2.5 1 0.7 5 0.6 0 0.0 10 1.2

WP KL 41 32.0 99 16.7 41 28.9 117 14.7 40 26.3 279 33.8

Total 128 100 592 100 142 100 795 100 152 100 825 1004th MRRB report 2010, Malaysia

Year of biopsy 2008 2009 2010 TotalAge group Age < 15 Age ≥ 15 Age < 15 Age ≥ 15 Age < 15 Age ≥ 15 Age < 15 Age ≥ 15State n % n % n % n % n % n % n % n %Johor 39 22.4 96 9.5 31 21.4 88 8.9 28 17 93 8.2 196 21.6 478 8.9Kedah 3 1.7 83 8.2 2 1.4 90 9.1 7 4.2 92 8.1 16 1.8 298 5.6Kelantan 3 1.7 24 2.4 1 0.7 11 1.1 5 3 59 5.2 13 1.4 158 3Melaka 1 0.6 21 2.1 1 0.7 32 3.2 0 0 11 1 7 0.8 128 2.4N.Sembilan 12 6.9 23 2.3 7 4.8 12 1.2 6 3.6 31 2.7 52 5.7 143 2.7Pahang 1 0.6 30 3 3 2.1 36 3.6 1 0.6 42 3.7 16 1.8 152 2.8Perak 0 0 17 1.7 0 0 8 0.8 1 0.6 59 5.2 6 0.7 200 3.7Perlis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Penang 18 10.3 110 10.9 23 15.9 112 11.3 22 13.3 134 11.8 114 12.6 623 11.7Sabah 15 8.6 2 0.2 6 4.1 3 0.3 7 4.2 0 0 39 4.3 130 2.4Sarawak 9 5.2 86 8.5 11 7.6 81 8.2 11 6.7 114 10.1 49 5.4 514 9.6

Selangor 26 14.9 226 22.4 21 14.5 291 29.4 39 23.6 261 23 149 16.4124

1 23.2Terengganu 0 0 4 0.4 0 0 11 1.1 0 0 9 0.8 3 0.3 54 1

WP KL 47 27 286 28.4 39 26.9 214 21.6 38 23 229 20.2 246 27.2122

4 22.9

Total 174 100 1008 100 145 100 989 100 165 100113

4 100 906 100534

3 100


Table 1.2.4.1(c): Age group distribution of reported renal biopsies by state, 2005-2010 (cont.)

Table 1.2.4.2(a): Gender distribution of native renal biopsy, 2005-2010

Gender2005 2006 2007 2008 2009 2010 Total

n n n n n n n %

Male 237 341 323 430 398 444 2173 40.1

Female 405 467 520 613 584 653 3242 59.9

Total 642 808 843 1043 982 1097 5415 100


Table 1.2.4.2(b): Gender distribution of renal allograft biopsy, 2005-2010

Gender2005 2006 2007 2008 2009 2010 Total

n n n n n n n %

Male 39 65 59 62 69 76 370 63.2

Female 23 36 36 41 35 44 215 36.8

Total 62 101 95 103 104 120 585 100


Table 1.2.4.3(a): Racial distribution of native renal biopsy, 2005-2010

Race 2005 2006 2007 2008 2009 2010 Total

n n n n n n n %

Malay 357 456 459 582 581 668 3103 57.3

Chinese 159 196 237 277 248 269 1386 25.6

Indian 46 59 61 70 70 53 359 6.6

Others 80 97 86 114 83 107 567 10.5

Total 642 808 843 1043 982 1097 5415 100


Table 1.2.4.3(b): Racial distribution of renal allograft biopsy, 2005-2010


Race 2005 2006 2007 2008 2009 2010 Total

n n n n n n n %

Malay 17 27 32 38 31 41 186 31.8

Chinese 36 61 49 47 60 59 312 53.3

Indian 5 10 9 11 9 12 56 9.6

Others 4 3 5 7 4 8 31 5.3

Total 62 101 95 103 104 120 585 100

Table 1.2.5: Number of glomeruli obtained at each biopsy by centres, 2005-2010


Table 1.2.6 (a): Distribution of biopsy specimens to local histopathology laboratories by participating centres, 2005-2010


Table 1.2.6(b): Distribution of biopsy specimens to outside histopathology laboratories by participating centres, 2005-2010



Table 1.2.6(b): Distribution of biopsy specimens to outside histopathology laboratories by participating centres, 2005-2010 (cont.)

Table 1.2.6(c): Summary of biopsies received by local and external laboratories, 2007-2010

2007 (1st report) 2008 (2nd report) 2009 (3rd Report) 2010 (4th Report)

n % n % n % n %

Local Lab 1085 44.9 1799 47.6 2360 48.5 2984 47.8

External Lab 1334 55.1 1978 52.4 2506 51.5 3265 52.2

All Lab 2419 100 3777 100 4866 100 6249 100


Table 1.2.6 (d): Histopathology laboratories receiving renal biopsy specimens, 2005-2010


Table 1.3.1(a): Indications for native renal biopsies, 2005-2010


Clinical Presentation2005 2006 2007 2008 2009 2010 Total

n % n % n % n % n % n % n %

Asymptomatic urine abnormality

168 25.9 218 26.6 236 27.7 321 30.3 277 27.7 367 32.8 1587 28.9

Nephritic syndrome 62 9.6 68 8.3 72 8.4 91 8.6 84 8.4 86 7.7 463 8.4

Nephrotic syndrome 310 47.8 373 45.5 394 46.2 469 44.3 420 42 456 40.8 2422 44

Nephrotic-Nephritic syndrome

21 3.2 38 4.6 53 6.2 103 9.7 137 13.7 131 11.7 483 8.8

Not available/Missing

88 13.6 122 14.9 98 11.5 74 7 83 8.3 79 7.1 544 9.9

Total 649 100 819 100 853 100 1058 100 1001 100 1119 100 5499 100

Table 1.3.1(b): Renal function at time of biopsy, 2005-2010

Renal function2005 2006 2007 2008 2009 2010 Total

n % n % n % n % n % n % n %

Normal361 55.6 416 50.8 475 55.7 580 54.8 495 49.5 581 51.9 2,908 52.9

Impaired150 23.1 239 29.2 293 34.3 400 37.8 430 43 460 41.1 1,972 35.9

Not available/Missing

138 21.3 164 20 85 10 78 7.4 76 7.6 78 7 619 11.3

Total 649 100 819 100 853 100 1058 100 1001 100 1119 100 5499 100


Table 1.3.2: Histopathology of all native renal biopsies, 2005-2010



Table 1.3.2: Histopathology of all native renal biopsies, 2005-2010 (cont.)

Table 1.3.3.1: HPE diagnosis in patients presenting with Nephritic Syndrome, 2005-2010

*Patients may have either one or more histopathology or not have any histopathologyOthers = Tubulo. Disease + Vascular + Advance GN + Others + Hereditary (no observation) 4th MRRB report 2010, Malaysia

Type Histopathological Diagnosis n %Primary GN

Minimal Change 666 27.1FSGS 536 21.8lg A nephropathy 117 4.8Membranous nephropathy 138 5.6Membrano-proliferative 24 1Mesangial Proliferative GN-non IgA 37 1.5Crescentic 0 0Idiopathic crescentic 7 0.3Not available/Missing 16 0.6Sub total 1541 62.6

Secondary GN

Other infection 6 0.2Lupus Nephritis 562 22.8Henoch Schonlein Purpura 3 0.1HUS/TTP 1 0Amyloidosis 6 0.2Systemic vasculitis 1 0Post infection GN 13 0.5Polyarteritis nodosa 0 0Malignancy 1 0Light/ heavy chain disease 1 0Diabetic nephropathy 95 3.9Anti GBM 0 0Immunotactoid / fibrillary GN 0 0Multiple myeloma 1 0Not available/Missing 9 0.4Sub total 699 28.4

Others 222 9Total 2462 100

Table 1.3.3.2: HPE diagnosis in Patients presenting with Asymptomatic Urine Abnormalities, 2005-2010

* Patients may have either one or more histopathology or not have any histopathologyOthers = Tubulo. Disease + Vascular + Advance GN + Others + Hereditary 4th MRRB report 2010, Malaysia


Minimal Change 95 6.1FSGS 147 9.4lg A nephropathy 236 15.1Membranous nephropathy 46 2.9Membrano-proliferative 4 0.3Mesangial Proliferative GN-non IgA 28 1.8Crescentic 4 0.3Idiopathic crescentic 10 0.6Not available/Missing 9 0.6Sub total 579 37.1

Secondary GN

Other infection 2 0.1Lupus Nephritis 697 44.7Henoch Schonlein Purpura 18 1.2HUS/TTP 0 0Amyloidosis 3 0.2Systemic vasculitis 1 0.1Post infection GN 17 1.1Polyarteritis nodosa 0 0Malignancy 0 0Light/ heavy chain disease 1 0.1Diabetic nephropathy 41 2.6Anti GBM 0 0Immunotactoid / fibrillary GN 0 0Multiple myeloma 4 0.3Missing 3 0.2Sub total 787 50.4

Others 194 12.4Total 1560 100

Table 1.3.3.3 : HPE diagnosis in patients presenting with Nephritic-Nephrotic, 2005-2010

* Patients may have either one or more histopathology or not have any histopathologyOthers = Tubulo. Disease + Vascular + Advance GN + Others + Hereditary (no observation) 4th MRRB report 2010, Malaysia


Minimal Change 34 6.6FSGS 41 8lg A nephropathy 40 7.8Membranous nephropathy 7 1.4Membrano-proliferative 8 1.6Mesangial Proliferative GN-non IgA 6 1.2Crescentic 1 0.2Idiopathic cresentic 5 1Sub total 142 27.7

Secondary GN

Other infection 3 0.6Lupus Nephritis 247 48.1Henoch Schonlein Purpura 5 1HUS/TTP 0 0Amyloidosis 0 0Systemic vasculitis 2 0.4Post infection GN 25 4.9Polyarteritis nodosa 0 0Malignancy 1 0.2Light/ heavy chain disease 0 0Diabetic nephropathy 16 3.1Anti GBM 0 0Immunotactoid / fibrillary GN 0 0Multiple myeloma 1 0.2Missing 1 0.2Sub total 301 58.7

Others 70 13.6Total 513 100

Table 1.3.3.4: HPE diagnosis in Patients presenting with Nephritic syndrome, 2005-2010

* Patients may have either one or more histopathology or not have any histopathologyOthers = Tubulo. Disease + Vascular + Advance GN + Others + Hereditary 4th MRRB report 2010, Malaysia


Minimal Change 30 6.5FSGS 40 8.6lg A nephropathy 39 8.4Membranous nephropathy 3 0.6Membrano-proliferative 7 1.5Mesangial Proliferative GN-non IgA 8 1.7Crescentic 4 0.9Idiopathic cresentic 9 1.9Unknown 4 0.9Sub total 144 31

Secondary GN

Other infection 0 0Lupus Nephritis 202 43.4Henoch Schonlein Purpura 5 1.1HUS/TTP 0 0Amyloidosis 1 0.2Systemic vasculitis 4 0.9Post infectious GN 34 7.3Polyarteritis nodosa 0 0Malignancy 0 0Light/ heavy chain disease 0 0Diabetic nephropathy 11 2.4Anti GBM 1 0.2Immunotactoid / fibrillary GN 0 0Multiple myeloma 0 0Sub total 258 55.5

Others 63 13.5Total 465 100

Table 1.3.3.5 : Table for Primary Glomerulonephritis, 2005-2010


Figure 1.3.3.5: Primary gromerulonephritis according to the various age group, 2005-2010

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

<15 15-<25 25-<35 35-<45 45-<55 55-<65 ≥65

Age group

Pe

rce

nta

ge

Minimal change disease FSGSIg A Nephropathy Membranous nephropathyMembrano proliferative Mesangial proliferative Non-Ig ACrescentic ANCA Idiopathic crescenticNot available/Missing

Documents

CHAPTER 1 Overview of Renal Biopsy in Malaysia Wan Sha’ariah Md Yusuf Lee Ming Lee Lee Day Guat