Chronic kidney disease (CKD) is a growing health concern in India, especially due to the increased prevalence of chronic diseases such as diabetes mellitus and hypertension (Mk, 1993). This study evaluates the prognostic significance of key biomarkers in CKD patients, including 24-hour urinary protein, estimated glomerular filtration rate (eGFR), and serum uric acid levels, alongside renal pathology and immunofluorescence findings. By assessing the relationships between these indicators, the research aims to enhance prognostic accuracy, predict CKD progression, and improve patient outcomes in the Indian context. The findings emphasize the importance of a comprehensive evaluation of these prognostic indicators in managing CKD effectively. Introduction: Chronic kidney disease (CKD) affects a substantial portion of the population in Indian subcontinent as well as globally, leading to adverse outcomes if not managed effectively. This paper aims to assess the utility of 24-hour urinary protein, eGFR, uric acid levels, renal pathology, and direct immunofluorescence findings as prognostic indicators in CKD. By exploring the relationships between these markers and disease progression, the study seeks to provide insights for personalized treatment strategies and improved patient care. Materials and Methods: This study was conducted as a retrospective, observational cohort study. Data has been collected from medical records of 50 CKD patients attending the nephrology OPD at MGM Medical college and Hospital, Kamothe, Navi Mumbai from the period of January 2022 to July 2023. Results: The study revealed significant correlations between 24-hour urinary protein, eGFR, uric acid levels, and specific renal pathologies. Higher levels of urinary protein and lower eGFR were robust predictors of CKD progression, while serum uric acid levels showed potential as a marker of disease severity. The findings underscored the importance of a comprehensive evaluation of prognostic indicators in CKD management. Conclusion: In conclusion, this research paper underscores the value of incorporating diverse prognostic indicators in CKD management to enhance diagnostic accuracy and treatment planning. By analyzing the interplay between traditional markers, renal pathology, and immunofluorescence findings, clinicians can refine prognostic models, predict CKD progression, and optimize patient outcomes. The study's insights offer valuable guidance for personalized care and improved prognostication in CKD patients.
Chronic kidney disease (CKD) affects a substantial portion of the population in Indian subcontinent as well as globally. According to the Screening and Early Evaluation of Kidney Disease (SEEK) study, the prevalence of CKD in India is estimated at 17.2% using the MDRD equation (1). Early diagnosis and effective management of CKD are essential in preventing the progression to end-stage renal disease and the need for renal replacement therapy.Various prognostic indicators have been studied to identify individuals at higher risk of CKD progression and poorer outcomes. However, the relationship between these prognostic indicators and specific renal pathologies is still unclear (2). This research proposal aims to evaluate the utility of prognostic indicators in predicting the progression and outcomes of chronic kidney disease, with a specific focus on their association with renal pathologies, using immunofluorescence findings and renal pathology as additional diagnostic tools.
Objectives:
This study was conducted as a retrospective, observational cohort study. Data has been collected from medical records of 50 CKD patients attending the nephrology OPD at MGM Medical college and Hospital, Kamothe, Navi Mumbai from the period of January 2022 to July 2023. The study aimed to evaluate the prognostic utility of 24-hour urinary protein, estimated glomerular filtration rate (eGFR), and uric acid levels in CKD patients, while also examining their correlations with renal pathology and immunofluorescence findings.
Inclusion Criteria:
Exclusion Criteria:
Data Collection
Data were collected from patient medical records and included:
24-hour Urinary Protein: Measured using standard laboratory methods and expressed as grams per 24 hours.
eGFR: Calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation based on serum creatinine levels.
Uric Acid: Serum uric acid levels measured using automated laboratory assays.
Renal Pathology and Immunofluorescence
Renal biopsy samples were meticulously analysed by experienced pathologists for histopathological findings. Immunofluorescence staining was performed on renal biopsy specimens by using FITC labelled antibodies to identify immune complex deposition to rule out the differentials given by the clinicians.
The study included a total of 50 CKD patients who met the inclusion criteria. The mean age of the participants was 45.06 years with Males represent 58% of the patients, while females account for 42%.
The correlation analysis assessed the relationships between the key prognostic indicators—24-hour urinary protein, estimated glomerular filtration rate (eGFR), and uric acid—with renal pathology and immunofluorescence findings in patients with chronic kidney disease (CKD).
|
Final Diagnosis |
Number of Cases |
Female |
Male |
|
Diabetic Nephropathy |
17 |
7 |
10 |
|
Crescentic Glomerulonephritis |
5 |
2 |
3 |
|
Membranoproliferative Glomerulonephritis |
7 |
2 |
5 |
|
Acute Tubular Necrosis |
2 |
0 |
2 |
|
Hypertensive Nephrosclerosis |
3 |
0 |
3 |
|
Focal Segmental Glomerulosclerosis |
1 |
1 |
0 |
|
Tubulointerstitial Nephritis |
6 |
2 |
4 |
|
Amyloidosis |
1 |
1 |
0 |
|
Lupus Nephritis |
6 |
5 |
1 |
|
Glomerulopathy |
1 |
1 |
0 |
|
Acute Tubular Injury |
1 |
1 |
0 |
Relationship Between Proteinuria Levels and Renal Pathologies
|
Proteinuria Severity |
Number of Cases |
|
Severe (>3.5 g/day) |
28 |
|
Moderate (0.3-3.5 g/day) |
22 |
The bar graph illustrates the distribution of moderate (0.3-3.5 g/day) and severe (>3.5 g/day) proteinuria cases based on final diagnosis. The data indicates that Diabetic Nephropathy had the highest frequency of severe proteinuria cases, while Tubulointerstitial Nephritis and Crescentic Glomerulonephritis also showed significant numbers of severe cases. Mean proteinuria levels (g/day) for each diagnosis were as follows: Glomerulopathy: 6.83, Acute Tubular Necrosis (ATN): 4.65, Acute Tubular Injury: 1.59, Amyloidosis: 1.10, Crescentic Glomerulonephritis: 3.74, Diabetic Nephropathy: 4.96, Focal Segmental Glomerulosclerosis (FSGS): 7.12, Hypertensive Nephrosclerosis: 1.39, Lupus Nephritis: 3.12, Membranoproliferative Glomerulonephritis (MPGN): 4.48, and Tubulointerstitial Nephritis: 5.77. These findings underscore the variability in proteinuria severity across different diagnoses, highlighting the need for tailored management strategies based on specific underlying conditions
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