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Changing the Incidence of Glomerular Diseases in Adults

Changing the Incidence of Glomerular Diseases in Adults. G. Braden, J. Mulhern, M. O’Shea, S. Nash, A. Ucci & J. Germain AJKD, Vol 35 No.5:2000; pp 878-83. Background. For the last 50 years, MN was the leading cause of Idiopathic NS in up to .5 of W and AA adults, whereas FSGS was .1-.15

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Changing the Incidence of Glomerular Diseases in Adults

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  1. Changing the Incidence of Glomerular Diseases in Adults G. Braden, J. Mulhern, M. O’Shea, S. Nash, A. Ucci & J. Germain AJKD, Vol 35 No.5:2000; pp 878-83 November 2000, Journal Club

  2. Background • For the last 50 years, MN was the leading cause of Idiopathic NS in up to .5 of W and AA adults, whereas FSGS was .1-.15 • 3 academic Ctrs. reported  FSGS in AA • No info on sm. urban (< 150 K population) & rural areas • No info on Hispanics

  3. Methods • Renal Bx & chart review from 1974-94 at Baystate Med. Ctr. in Springfield, Mass. • >18 y.o, 2 gm proteinuria/day, 5 yr intervals • Excluded: IVDA, HIV, SS, VUR, meds, tumors, Hep B, MPGN (2o to cryoglob or hepatitis), collagen, SLE, Crescentic GN, Acute Prolif. GN, Focal necrotizing GN, vasculitis, amyloidosis & fibrilary GN

  4. Results • Sample: 965, eligible n = 616 adults • AA catchment pop. in 20 years .056  .065 • 2o FSGS went from 0 in the 1st and 2nd quartiles, to .12 (3rd q) to .06 (4th q) • 2o MN: .3 in the 1st.12 .15 .06 • No sig.  in other 1o Glomerulopathies • 1990-94  new FSGS 15 vs. MN 7 (p<.05)

  5. Discussion (1):Idiopathic FSGS Increase •  Unlikely due to detection (tissue levels on light microscopy/Bx = in 20 years) •  Unlikely due to frequency of 2o causes of FSG or MN because these patients  along with the idiopathic FSGS cases. • No  in 2o MN that could  Idiopathic MN

  6. Discussion (2):Idiopathic FSGS Increase • FSGS  in AA & H (significantly) & in W • No  in age and sex distribution in 20 y. • Inclusion of all 2 g/d proteinuria, not all patients had NS  overestimation • Most Hispanics from Puerto Rico

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