Glomerular Disease in Adults in the Northeast of Brazil: A Clinical and Pathological
Study.
Suzana M. Melo, Lucila V. Lopes, Alina Cavalcante, Alexis Harris, Sandra N. Coelho, Charles Jennette.
Nephrology, Federal University of Pernambuco, Recife PE, Brazil; Pathology, University of North Carolina,
Chapel Hill, NC.

To determine the causes of glomerular disease in the northeastern Brazil (which has not been previously determined) and to identify any associated infections, renal biopsies were performed in 85 patients with glomerular diseases who were cared for in the Nephrology Division, FUPE, between April 1997 and January 1999. Specimens were placed in B5 fixative for light microscopy, glutaraldehyde for electron microscopy, or Michael's transport medium for immunofluorescence microscopy; and transported by express mail to PD-UNC, USA. Pathologic diagnosis was made by two of the authors (SMM & JCJ). All patients had serologic evaluation for HCV, HBV, HIV, and SLE as well as other diagnostic tests appropriate for the
evaluation of glomerular diseases, and tests for infection with Schistosoma mansoni (SM). The median age was 27 years (range: 16 to 75 years); 49 patients were female (58%), 53 patients white (62%), and 32 black (38%). The biopsy indications were nephrotic syndrome in 49 patients (58%) with or without hematuria, persistent non-nephrotic proteinuria in 22 (26%), isolated microscopic hematuria or nephritic syndrome in 12 (14%), and renal insufficiency plus hematuria in 2 (2%). Type I  embranoproliferative (mesangiocapillary) glomerulonephritis (MPGN) was the most common diagnosis (n=20, 23.5% of patients), followed by focal segmental glomerulosclerosis (FSGS) (n=15, 17.6%), minimal change disease (MCD) (n=10, 11.7%), lupus GN (n=10, 11.7%), membranous GN (n=8, 9.4%), other immune complex-mediated glomerulonephritis (ICGN) (n=6, 7.0%), IgA mesangial nephropathy (n=3, 3.5%), other proliferative GN (n=3, 3.5%), and miscellaneous other (n=7, 8.2%). Of the 85 patients, 5 had SM infection (4.3%), 2 HCV infection (1.7%), and 1 HBV infection (0.9%), for a total of 8 infections (6.9%). Of the 20 MPGN patients, 5 (25%) had infections, 3 SM (15%) and 2 HCV (10%). Of the 65 other patients, only 3 (5%) had infections (1 ICGN with SM, 1 MCD with SM, and 1 membranous GN with HBV). CONCLUSIONS: MPGN is the most common glomerular disease in northeastern Brazil, which is similar to other developing and undeveloped countries, but different from developed countries where MPGN is relatively rare. MPGN was more frequently associated with chronic infections than the other glomerular diseases, especially SM, which suggests a peri-infectious pathogenesis. 
Poster Session: Glomerular and Tubular Disorders: Risk Factors/Outcomes I (9:30 AM-5:00 PM)
Presentation Date: Friday, November 5, 1999, Time: 9:30AM, Room: Halls B and C.