3rdReport renal biopsy 2009
3rd REPORT of
the MALAYSIAN REGISTRY of
RENAL BIOPSY 2009
Editors:
Rosnawati Yahya
Wan Jazilah Wan Ismail
With contributions from:
Wan Shaariah, Sunita B, Yap Y C, Wong H S, Lee DG, Lim J Y, Premaa S, Tassha H A
Malaysian Society of Nephrology
Ministry of Health Malaysia
3rd REPORT OF
THE MALAYSIAN REGISTRY
of
RENAL BIOPSY
2009
Sponsors:
Malaysian Society of Nephrology
The National Renal Registry is funded with grants from:
The Ministry of Health Malaysia
Roche
Ain Medicare
Baxter Healthcare
Fresenius Medical Care
i
December 2011
© National Renal Registry, Malaysia
ISSN 1985-6989
Published by:
The National Renal Registry
Malaysian Society of Nephrology
Suite 1604, Plaza Permata
No. 6, Jalan Kampar
50400 Kuala Lumpur
Malaysia
Telephone. : (603) 4045 8636
Direct Fax : (603) 4042 7694
e-mail
: nrr@msn.org.my
Web site : http://www.msn.org.my
Cover illustration by Dr. Nik Hasimah Nik Yahya HKL
Important information:
This report is copyrighted. However it may be freely reproduced without the permission of the
National Renal Registry. Acknowledgment would be appreciated. Suggested citation is:
Rosnawati Yahya, Wan Jazilah W I (Eds) First Report of the Malaysian Registry of Renal Biopsy.
Kuala Lumpur 2008
This report is also published electronically on these websites http://www.msn.org.my or https://
www.macr.org.my/emrrb .
ii
ACKNOWLEDGEMENTS
The National Renal Registry would like to thank the following:
All the nephrologists and staff of the participating hospitals
For their hard work and contribution,
The Ministry of Health, Malaysia
for support seen and unseen,
For their generous support: Roche
Ain Medicare
Baxter Healthcare
Fresenius Medical Care
The staff of the Clinical Research Centre
&
All who have in one way or another supported the National Renal
Registry.
iii
NRR ADVISORY COMMITTEE MEMBERS
2010 TO 2012
Members:
MSN appointment:
Facilities
Datuk Dr. Ghazali Ahmad
Chairman
Hospital Kuala Lumpur
Dr. Abdul Halim Abd Gafor
University representative
Dr. Goh Bak Leong
MINR sub-committee Chairperson
University Kebangsaan
Malaysia Medical Centre
Hospital Serdang
MDTR advisor
Independent Consultant
Nephrologist
MDTR sub-committee Chairperson
Hospital Kuala Lumpur
Dr. Ong Loke Meng
CRC representative
Hospital Penang
Dr. Rafidah Abdullah
Honorary MSN Treasurer
Hospital Selayang
Dr. S. Prasad Menon
Private sector representative
Sime Darby Medical
Centre Subang Jaya
Hospital Selayang
Dr. Lim Teck Onn
Dr. Lim Yam Ngo
Dr. Wong Hin Seng
eMOSS sub-committee Chairperson
Dato' Dr. Wan Shaariah Md Yusuf
MRRB sub-committee Chairperson
Tuanku Ja'afar Hospital
Dato' Dr. Zaki Morad B Mohd Zaher
NGO representative
National Kidney
Foundation
Mr. Husin Harun
ADMAN representative
Hospital Kuala Lumpur
Clinical Registry Manager
Lee Day Guat
Clinical Research Assistant
Suhazelini Ali
Choo Cheh Loo
Statistician
Premaa A/P Supramaniam
Tassha Hilda binti. Adnan
Adam bin Bujang
MRRB WORKING COMMITTEE MEMBERS
Chairperson
Dato’ Dr. Wa Sha’ariah Md Yusuf
Co-Chairperson
Members
Dr. Rosnawati Yahya
Dr. Lim Soo Kun
Dr. Sunita Bavanandan
Dr. Wan Jazilah Wan Ismail
Dr. Wong Hin Seng
Dr. Yap Yoke Chin
iv
ABOUT MALAYSIAN REGISTRY OF RENAL BIOPSY
Renal biopsy remains the main investigation in the diagnosis of renal diseases. In addition, it plays a
major role in determining the management and prognosis of parenchymal renal disease. The
collection of demographic, clinical and laboratory data at the time of biopsy and the set up of a
database are useful tools for studying renal parenchymal diseases.
The development of a renal biopsy registry in each country promotes many advantages and these
include comparison in incidence of renal diseases, identification of different policies and practices in
renal biopsy in different areas, linkage with other registries such as dialysis or transplant registry and
identification of rare renal diseases. Thus, the registry is a source of epidemiological data and would
provide useful information in the planning of health care and in organizing prospective clinical studies.
The incidence of glomerular disease varies according to population, demographic characteristics,
environmental factors, socio-economic status and the prevalence of infectious diseases. At present,
there is limited information on the prevalence and incidence of glomerular disease, its potential
disease burden and the temporal trend in Malaysia. Hence, the Malaysian Registry of Renal Biopsy
(MRRB) was set up in 2005 to address this deficiency.
The MRRB collects information about patients who undergo renal biopsy in Malaysia. The MRRB is a
new component of National Renal Registry (NRR), which has been operating the Malaysian Dialysis
and Transplant Registry (MDTR) since 1993.
Objectives
The objectives of the MRRB registry are to:
1. Determine the disease burden attributable to glomerular disease (GD) by quantifying its incidence
and prevalence, and its geographic and temporal trends in Malaysia.
2. Identify subgroups in the population at high risk of GD to whom preventive efforts should be
targeted.
3. Identify potential causal and risk factors involved in GD.
4. Describe the clinical presentation and spectrum of GD.
5. Stimulate and facilitate basic, clinical and epidemiological research on GD.
6. Identify causes of allograft failure in our renal transplant population.
7. To audit the renal biopsy procedure, monitor both complications and quality of specimens in
addition to identifying risk factors associated with complications.
v
Organization
The NRR organization is as follows:
Owner
(MSN)
Sponsors
(MSN & MOH)
NRR Advisory
Committee
MRRB
Steering
Committee
NRR co-coordinating office
Source Data Providers
Target groups or Users
Owner
The Malaysian Society of Nephrology (MSN) is the owner of this registry.
Sponsors
The MRRB is sponsored by the Malaysian Society of Nephrology (MSN) and the Ministry of Health,
Malaysia.
NRR Advisory Committee
This is the o
ittee esta lished y the spo sors. The NRR Advisory Co
ittee’s role is to e sure
that the MRRB stay focused on its objectives and to assure its continuing relevance and justification.
MRRB Steering Committee
The MRRB Working Committee supervises its operations.
National Renal Registry office
The NRR coordinating office is the designated coordinating center. It coordinates the data collection
among the Source Data Providers (SDPs). It collaborates with Clinical Research Centre of Hospital
Kuala Lumpur that provides epidemiological and statistical support for MRRB.
Source Data Providers (SDP)
These are centres that contribute the required data for MRRB. The SDP collects and enters data
directly through the on-line web-base system. The pilot phase of the registry consists of SDPs from
Ministry of Health.
Throughout this initial phase, we have refined and improved the database. In 2008, the registry is
expanding to a national level to include participation from all nephrologists and renal physicians in
Malaysia who perform renal biopsies. We hope the nephrology community will support us by
submitting information, which is crucial to eventually improve the management of patients with
Chronic Kidney Disease (CKD).
vi
To participate in MRRB
Centres interested to participate in this registry please write in to NRR officially via post or email
nrr@msn.org.my.
The following documents need to be completed and returned to facilitate participation.
Centre Participation Self Reply Form
Authorization Form
Information Security Policy/User Agreement . One form per nominee as listed in the Authorization
form. Users must have a personal mobile phone to received SMS authentication.
Upon receiving these documents, the centre shall be registered and each of the users of the MRRB
shall be notified via their e-mail address.
Methodology
All patients from participating centres who undergo any kidney biopsy (native or graft) are to be
enrolled into the registry.
On-line data submission is through MRRB web application or paper CRF. The data variables collected
include demography, clinical presentation, and indication of biopsy, renal function, and laboratory
data at presentation and at the time of biopsy, serological markers, virology status and
histopathological result. In addition, an update on outcomes in terms of significant end-points such as
end stage renal disease or death will be recorded annually.
vii
DATA CONTRIBUTING CENTRES
Adult Centre Name
Sector
96 Hospital Angkatan Tentera Lumut
Hospital Pakar Sultanah Fatimah Muar
Kuala Lumpur Hospital
Melaka Hospital
Pulau Pinang Hospital
Queen Elizabeth Hospital
Raja Perempuan Zainab II Hospital
Raja Permaisuri Bainun Hospital
Sarawak General Hospital
Selayang Hospital
Serdang Hospital
Sultanah Aminah Hospital
Sultanah Bahiyah Hospital
Sultanah Nur Zahirah Hospital
Tengku Ampuan Afzan Hospital
Tengku Ampuan Rahimah Hospital
Tuanku Ja'afar Hospital
Fan Medical Renal Clinic
Ipoh Specialist Hospital
KPJ Ampang Puteri Specialist Hospital
KPJ Selangor Specialist Hospital
Lam Wah Ee Hospital
Metro Specialist Hospital
Normah Medical Specialist Centre
Prince Court Medical Centre
Sunway Medical Centre
Teo Kidney Specialist Clinic
Timberland Medical Centre
Tung Shin Hospital
University Malaya Medical Centre
Universiti Sains Malaysia Hospital
All
Armed forces
MOH
MOH
MOH
MOH
MOH
MOH
MOH
MOH
MOH
MOH
MOH
MOH
MOH
MOH
MOH
MOH
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
University
University
Paediatric Centre Name
Sector
Kuala Lumpur Hospital
Likas Hospital
Pulau Pinang Hospital
Selayang Hospital
Sultan Ismail Hospital
Tengku Ampuan Afzan Hospital
Tuanku Ja'afar Hospital
All
MOH
MOH
MOH
MOH
MOH
MOH
MOH
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CONTRIBUTING EDITORS
Chapter
1
2
Title
Authors
Institutions
Overview of Renal Biopsy in
Malaysia
Wa Sha’ariah Md Yusuf
Tua ku Ja’afar Hospital
Lee Ming Lee
Tua ku Ja’afar Hospital
Lee Day Guat
National Renal Registry
Sunita Bavanandan
Kuala Lumpur Hospital
Lim Soo Kun
University Malaya Medical
Centre
Primary Glomerulonephritis
3
Secondary Glomerulonephritis
Rosnawati Yahya
Kuala Lumpur Hospital
4
Paediatric Renal Biopsy
Lee Ming Lee
Tua ku Ja’afar Hospital
Lim Yam Ngo
Kuala Lumpur Hospital
Lynster Liaw
Pulau Pinang Hospital
Susan Pee
Sultan Ismail Hospital
Wan Jazilah Wan Ismail
Selayang Hospital
Yap Yoke Chin
Kuala Lumpur Hospital
Selvakumar Sivapunniam
Tengku Ampuan Afzan Hospital
Wong Hin Seng
Selayang Hospital
5
Renal Allograft Biopsy
Report Editors
Rosnawati Yahya
Wan Jazilah Wan Ismail
ix
CONTENTS
x
CHAPTER 1
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
1.1
Introduction
1.2
Renal biopsies from the participating centres
1.2.1
Ascertainment rate of total biopsy performed
1.2.2
Type of renal biopsy performed
1.2.3
Number of renal biopsy done on each individual patient
1.2.4
Demographic distribution of renal biopsy (Native and Graft)
1.2.4.1 Age distribution
1.2.4.2 Gender distribution
1.2.4.3 Racial distribution
1.2.5
Renal biopsy report analysis
1.2.6
Histopathology specimen distribution to histopathology laboratories
1.3
Native kidney biopsy
1.3.1
Clinical Indications of renal biopsy
1.3.2
Histopathological diagnosis
1.3.3
Histopathology findings in common clinical presentation
1.3.3.1 Histopathological diagnosis in patients with nephrotic syndrome
1.3.3.2 Histopathological diagnosis in patients with urinary abnormalities
1.3.3.3 Histopathological diagnosis in patients with nephritic-nephrotic
syndrome
1.3.3.4 Histopathological diagnosis in patients with nephritic syndrome
1.3.3.5 Primary GN according to various age group
1
2
2
2
4
6
7
7
9
9
10
11
14
14
14
17
17
18
CHAPTER 2
PRIMARY GLOMERULONEPHRITIS
2.1
Introduction
2.2
Minimal Change Disease
2.2.1
Introduction
2.2.2
Patient population and characteristics
2.2.3
Clinical presentation
2.2.3.1 Clinical presentation by age
2.2.3.2 Clinical presentation by gender
2.3
Focal Segmental Glomerulosclerosis
2.3.1
Introduction
2.3.2
Patient population and characteristics
2.3.3
Clinical Presentation
2.3.3.1 Clinical presentation by age
2.3.3.2 Clinical presentation by gender
2.4
Idiopathic Membranous Nephropathy
2.4.1
Introduction
2.4.2
Patient population and characteristics
2.4.3
Clinical presentation
2.4.3.1 Clinical Presentation by age
2.4.3.2 Clinical presentation by gender
23
24
24
24
25
26
27
28
29
29
29
30
31
32
33
33
33
34
35
36
19
20
21
CONTENT
2.5
con’t
IgA Nephropathy (IgAN)
2.5.1
Introduction
2.5.2
Patient population and characteristics
2.5.3
Clinical presentation
2.5.3.1
Clinical presentation by age
2.5.3.2
Clinical presentation by gender
CHAPTER 3
SECONDARY GLOMERULONEPHRITIS
3.1
Introduction
3.2
Lupus Nephritis
3.2.1
Introduction
3.2.2
Patient population and characteristics
3.2.2.1
Age at time of biopsy
3.2.2.2
Gender distribution
3.2.2.3
Racial prevalence
3.2.3
Clinical presentation
3.2.3.1
Clinical Presentation by age
3.2.3.2
Clinical presentation by gender
3.2.3.3
Clinical Presentations by histopathology
3.2.4
Renal function at presentation
3.2.4.1
Renal function at presentation by age group
3.2.4.2
Renal function at presentation by gender
3.2.4.3
Renal function at presentation by histopathology
3.2.5
Histopathological diagnosis
3.2.5.1
Histopathological diagnosis by age
3.2.5.2
Histopathological diagnosis by gender
3.2.5.3
Histopathological diagnosis by clinical presentation
3.2.6
Extra-renal involvement
3.2.6.1
American Rheumatological Association (ARA) criteria in lupus
nephritis
3.2.6.2
ARA criteria in lupus nephritis by age
ARA criteria in lupus nephritis by gender
3.2.6.3
3.2.6.4
ARA criteria in lupus nephritis by histopathological findings
3.2.6.5
Extra-renal involvement
3.2.7
Survival in lupus nephritis
3.2.7.1
Patient survival in lupus nephritis
Renal survival in lupus nephritis
3.2.7.2
CHAPTER 4
PAEDIATRIC RENAL BIOBSY
4.1
Introduction
4.2
Number of patients and renal biopsies
4.2.1
Total number of patients and native renal biopsies
4.2.2
Number of patients from various hospitals
4.2.3
Number of native renal biopsies
37
37
37
38
39
39
43
44
44
44
44
45
46
46
47
48
49
50
50
51
51
52
52
52
53
54
54
54
54
55
56
57
57
58
59
60
60
60
60
60
xi
CONTENT
4.3
4.4
4.5
4.6
4.7
4.8
4.9
4.10
4.11
con’t
Outcome of renal biopsies
4.3.1
Adequacy of renal biopsy for diagnosis
4.3.2
Number of glomeruli obtained at each biopsy
Patient characteristics
Clinical presentation
4.5.1
Clinical presentation at biopsy
Histopathological findings of paediatric renal biopsies
4.6.1
Diagnosis of paediatric renal biopsies
4.6.2 Annual frequency of main renal biopsy findings
Renal histopathology diagnosis of children presenting with nephrotic syndrome
Renal histopathology diagnosis of children presenting with nephritic syndrome
Paediatric lupus nephritis
4.9.1
Patient characteristics of paediatric lupus nephritis
4.9.2
Extra renal manifestations of paediatric SLE
4.9.3
Clinical presentation at biopsy (SLE)
4.9.4
Classification of paediatric lupus nephritis
4.9.5
Paediatric Patient survival in lupus nephritis
4.9.6
Renal survival of paediatric patients with lupus nephritis
Renal outcome
Biopsy failure and complications
61
61
61
61
62
62
62
62
62
64
64
65
65
66
66
66
67
67
68
68
References
CHAPTER 5
RENAL ALLOGRAFT BIOPSY
5.1
Introduction
5.2
Number of renal allograft biopsy
5.2.1
Number of renal allograft biopsy by year
5.2.2
Number of renal allograft biopsy by year and site
5.2.3
Number of renal allograft biopsy by year and age group
5.3
Clinical presentation at biopsy
5.4
Timing of renal allograft biopsy
5.5
Renal allograft biopsy Procedure
5.5.1
Renal allograft Biopsy method
5.5.2
Number of passes
5.5.3
Number of glomeruli obtained on biopsy
5.5.4
Type of complications
5.6
Histological diagnosis
Appendix I
Appendix II
Appendix III
Appendix IV
xii
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72
72
72
72
74
75
76
77
77
78
79
80
80
83
87
91
92
LIST OF TABLES
Page
Table 1.2.1 (a)
Table 1.2.1 (b)
Table 1.2.2
Table 1.2.3 (a)
Table 1.2.3 (b)
Table 1.2.4.1 (a)
Table 1.2.4.1 (b)
Table 1.2.4.1 (c)
Table 1.2.4.2 (a)
Table 1.2.4.2 (b)
Table 1.2.4.3 (a)
Table 1.2.4.3 (b)
Table 1.2.5
Table 1.2.6 (a)
Table 1.2.6 (b)
Table 1.2.6 (c)
Table 1.3.1 (a)
Table 1.3.1 (b)
Table 1.3.2
Table 1.3.3.1
Table 1.3.3.2
Table 1.3.3.3
Table 1.3.3.4
Table 1.3.3.5
Table 2.1
Table 2.2.2 (b)
Table 2.2.3 (a)
Table 2.2.3 (b)
Table 2.2.3 (c)
Table 2.2.3.2(a)
Table 2.2.3.2 (c)
Table 2.3.2 (b)
Table 2.3.3 (a)
Total number of reported and unreported renal biopsies by centres,
2005-2009
Total number of reported and unreported renal biopsies,2005-2009
Distribution of reported native and graft renal biopsies by centres, 20052009
Distribution of native renal biopsy in patients by number of episodes,
2005-2009
Distribution of renal allograft biopsy in patients by number of episodes,
2005-2009
Age distribution of native renal biopsy, 2005-2009
Age distribution of renal allograft biopsy, 2005-2009
Age group distribution of reported renal biopsies by state, 2005-2009
Gender distribution of native renal biopsy, 2005-2009
Gender distribution of renal allograft biopsy, 2005-2009
Racial distribution of native renal biopsy, 2005-2009
Racial distribution of renal allograft biopsy, 2005-2009
Number of glomeruli obtained at each biopsy by centres, 2005-2009
Distribution of biopsy specimens to histopathology laboratories by
participating centres, 2005-2009
Summary of biopsies received by local and external laboratories, 20072009
Histopathology laboratories receiving renal biopsy specimens, 20052009
Indications for native renal biopsies, 2005-2009
Renal function at time of biopsy
Histopathology of all native renal biopsies, 2005-2009
HPE diagnosis in patients presenting with nephrotic syndrome, 20052009
HPE diagnosis in patients presenting with urine abnormalities, 20052009
HPE diagnosis in patients presenting with nephritic-nephrotic syndrome,
2005-2009
HPE diagnosis in patients presenting with nephritic syndrome, 20052009
Primary GN according to the various age group, 2005-2009
Primary Glomerulonephritis, 2005-2009
Age group at time of biopsy (years) for MCD, 2005-2009
Clinical presentation for MCD, 2005-2009
Presence of hypertension in MCD, 2005-2009
Renal function in MCD by year, 2005-2009
Clinical presentation by gender for MCD, 2005-2009
Renal function by gender for MCD, 2005-2009
Age group at time of biopsy (years) for FSGS, 2005-2009
Clinical presentation for FSGS, 2005-2009
2
4
4
6
6
7
7
8
9
9
9
9
10
11
13
13
14
14
15
17
18
19
20
21
24
25
26
26
27
28
28
29
30
xiii
LIST OF TABLES
Table 2.3.3 (b)
Table 2.3.3 (c)
Table 2.3.3.1 (a)
Table 2.3.3.2 (a)
Table 2.4.3 (a)
Table 2.4.3 (b)
Table 2.4.3 (c)
Table 2.4.3.1 (a)
Table 2.4.3.1 (c)
Table 2.4.3.2 (a)
Table 2.4.3.2 (b)
Table 2.5.3 (a)
Table 2.5.3 (b)
Table 2.5.3 (c)
Table 2.5.3.1 (a)
Table 2.5.3.1 (b)
Table 2.5.3.1 (c)
Table 2.5.3.2 (a)
Table 3.1
Table 3.2.2.1
Table 3.2.3.1 (a)
Table 3.2.3.3 (a)
Table 3.2.4.1
Table 3.2.4.3
Table 3.2.5
Table 3.2.5.1
Table 3.2.5.2
Table 3.2.5.3
Table 3.2.6.1
Table 3.2.6.4
Table 3.2.6.5 (a)
Table 3.2.6.5 (b)
Table 3.2.7.2
Table 3.2.7.3
Table 4.2.2
Table 4.2.3
Table 4.3.1
Table 4.3.2
Table 4.4.1
Table 4.4.2
Table 4.5.1
Table 4.6.1
Table 4.6.2
Table 4.7.1
xiv
con’t
Presence of hypertension in FSGS, 2005-2009
Renal function in FSGS by year, 2005-2009
Clinical presentation by age group for FSGS, 2005-2009
Clinical presentation by gender for FSGS, 2005-2009
Clinical presentation for IMN, 2005-2009
Presence of hypertension in IMN, 2005-2009
Renal function in IMN, 2005-2009
Clinical presentation by age group for IMN, 2005-2009
Renal function at presentation by age group for IMN, 2005-2009
Clinical presentation by gender for IMN, 2005-2009
Hypertension by gender for IMN, 2005-2009
Clinical presentation for IgA nephropathy, 2005-2009
Presence of hypertension in IgA nephropathy, 2005-2009
Renal function in IgA Nephropathy, 2005-2009
Clinical presentation by age group for IgA nephropathy, 2005-2009
Hypertension by age group for IgA nephropathy, 2005-2009
Renal function at presentation by age group for IgA nephropathy, 20052009
Clinical presentation by gender for IgA nephropathy, 2005-2009
Causes of secondary glomerulonephritis in adult, 2005-2009
Age group at time of biopsy (years), 2005-2009
Clinical presentation by age group, 2005-2009
Clinical presentations by histopathology in lupus nephritis, 2005-2009
Renal function by age group in lupus nephritis, 2005-2009
Renal function at presentation by histopathology, 2005-2009
Histopathological diagnosis in lupus nephritis by year, 2005-2009
Histopathological diagnosis by age group in lupus nephritis, 2005-2009
Histopathological diagnosis by gender in lupus nephritis, 2005-2009
Histopathological diagnosis by clinical presentation in lupus nephritis,
2005-2009
ARA criteria in lupus nephritis, 2005-2009
ARA criteria by histopathology, 2005-2009
Extra-renal involvement by gender, 2005-2009
Mucocutaneous involvement by gender in lupus nephritis, 2005-2009
Patients survival estimates for death in lupus nephritis
Renal survival estimates for lupus nephritis
Number of patients from various hospitals
Number of renal biopsies
Conclusive report
Number of glomeruli obtained at each biopsy
Gender and racial distribution
Age distribution
Clinical presentation at biopsy
Diagnosis of paediatric renal biopsies
Annual frequency of the main renal biopsy findings 1999-2009
Renal histopathology diagnosis of children presenting with nephrotic
syndrome
Page
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32
34
34
34
35
35
36
36
38
38
39
39
40
40
40
44
45
47
49
50
51
52
52
53
53
54
55
56
57
58
58
60
60
61
61
61
61
62
62
63
64
LIST OF TABLES
con’t
Page
Table 4.8
Table 4.9.1 (a)
Table 4.9.2(a)
Table 4.9.2(b)
Table 4.9.3
Table 4.9.4
Table 4.9.5
Table 4.9.6
Table 4.10
Table 4.11(a)
Table 4.11(b)
Table 5.2.1
Table 5.2.2
Table 5.2.3
Table 5.3
Table 5.4
Table 5.5.1
Table 5.5.2
Table 5.5.3
Table 5.5.4
Table 5.6
Renal histopathology diagnosis of children presenting with nephritic
syndrome
Demographic characteristic of paediatric lupus nephritis
Clinical presentations of paediatric SLE
ARA criteria at presentation
Clinical presentation at biopsy (SLE)
Classification of paediatric lupus nephritis
Patients survival in lupus nephritis
Renal survival of patients with lupus nephritis
Causes of end stage renal disease in children who underwent renal
biopsy
Frequency of complications
Risk factors for complication
Number of renal allograft biopsy, 2005-2009
Number of renal allograft biopsy by centre, 2005-2009
Renal allograft biopsy by year and age group, rate (per million
population), 2005-2009
Indications for renal allograft biopsy, 2005-2009
Timing of renal allograft biopsy, 2005-2009
Biopsy method, 2005-2009
Number of passes, 2005-2009
Number of glomeruli obtained on biopsy, 2005-2009
Type of complications, 2005-2009
Histological diagnosis, 2005-2009
64
65
65
65
66
66
67
67
68
68
69
72
73
74
75
76
77
78
79
80
80
xv
LIST OF FIGURES
Figure 1.3.3.5
Figure 2.2.2 (a)
Figure 2.2.2 (b)
Figure 2.2.3 (a)
Figure 2.2.3.1 (a)
Figure 2.2.3.1 (b)
Figure 2.2.3.1 (c)
Figure 2.2.3.2 (b)
Figure 2.3.2(a)
Figure 2.3.2 (b)
Figure 2.3.3 (a)
Figure 2.3.3.1 (a)
Figure 2.3.3.1 (b)
Figure 2.3.3.1 (c)
Figure 2.3.3.2 (a)
Figure 2.3.3.2 (b)
Figure 2.3.3.2 (c)
Figure 2.4.2 (a)
Figure 2.4.2 (b)
Figure 2.4.3 (a)
Figure 2.4.3.1
Figure 2.4.3.2 (a)
Figure 2.4.3.2 (c)
Figure 2.5.2 (a)
Figure 2.5.2 (b)
Figure 2.5.3 (a)
Figure 2.5.3.1(a)
Figure 2.5.3.2 (a)
Figure 2.5.3.2 (b)
Figure 2.5.3.2 (c)
Figure 3.2.2.1
Figure 3.2.2.2
Figure 3.2.2.3
Figure 3.2.3
Figure 3.2.3 (a)
Figure 3.2.3 (b)
Figure 3.2.3.1 (a)
Figure 3.2.3.1 (b)
Figure 3.2.3.1 (c)
Figure 3.2.3.2 (a)
Figure 3.2.3.2 (b)
xvi
Primary GN according to the various age group, 2005-2009
Demographic characteristics for MCD, 2005-2009
Age at time of biopsy (years) for MCD, 2005-2009
Overall clinical presentation for MCD, 2005-2009
Clinical presentation by age group for MCD, 2005-2009
Hypertension by age group for MCD, 2005-2009
Renal function at presentation by age group for MCD, 2005-2009
Hypertension by gender for MCD, 2005-2009
Demographic characteristics for FSGS, 2005-2009
Age at time of biopsy (years) for FSGS, 2005-2009
Overall clinical presentation for FSGS, 2005-2009
Clinical presentation by age group for FSGS,2005-2009
Hypertension by age group for FSGS, 2005-2009
Renal function at presentation by age group for FSGS, 2005-2009
Clinical presentation by gender FSGS, 2005-2009
Hypertension by gender for FSGS, 2005-2009
Renal function at presentation by gender for FSGS, 2005-2009
Demographic characteristics for IMN, 2005-2009
Age at time of biopsy (years) IMN, 2005-2009
Overall clinical presentation for IMN, 2005-2009
Clinical presentation by age group for IMN 2005-2009
Clinical presentation by gender for IMN, 2005-2009
Impaired renal function by gender, 2005-2009
Demographic characteristics of patients with IgA nephropathy, 20052009
Age at time of biopsy (years) for IgA nephropathy, 2005-2009
Overall clinical presentation for IgA nephropathy, 2005-2009
Clinical presentation by age group for IgA nephropathy, 2005-2009
Clinical presentation by gender for IgA nephropathy, 2005-2009
Hypertension by gender for IgA nephropathy, 2005-2009
Impaired renal function by gender in, 2005-2009
Age group at time of biopsy (years), 2005-2009
Gender distribution in lupus nephritis, 2005-2009
Racial distribution in lupus nephritis, 2005-2009
Clinical presentation by year, 2005-2009
Hypertension by year in lupus nephritis, 2005-2009
Impaired renal function by year in lupus nephritis, 2005-2009
Clinical presentation by age group in lupus nephritis, 2005-2009
Hypertension by age group in lupus nephritis, 2005-2009
Impaired renal function by age group in lupus nephritis, 2005-2009
Clinical presentation by gender in lupus nephritis, 2005-2009
Hypertension by gender in lupus nephritis 2005-2009
Page
22
25
25
26
27
27
27
28
29
29
30
31
31
31
32
32
32
33
33
34
35
36
36
37
37
38
39
41
41
41
45
45
46
46
47
47
47
48
48
48
48
LIST OF FIGURES
Figure 3.2.3.2 (c)
Figure 3.2.3.3 (a)
Figure 3.2.3.3 (b)
Figure 3.2.3.3 (c)
Figure 3.2.4.1
Figure 3.2.4.2
Figure 3.2.6.2
Figure 3.2.6.3
Figure 3.2.6.4
Figure 3.2.6.5 (a)
Figure 3.2.6.5 (b)
Figure 3.2.7.1
Figure 3.2.7.2:
Figure 3.2.7.3
Figure 4.9.5
Figure 4.9.6
Figure 5.2.1
Figure 5.2.3
Figure 5.4
Figure 5.5.1
Figure 5.5.2
Figure 5.5.3
Figure 5.5.6
con’t
Impaired renal function by gender in lupus nephritis, 2005-2009
Clinical presentations by histopathology in lupus nephritis, 2005-2009
Hypertension by histopathology in lupus nephritis, 2005-2009
Impaired renal function by histopathology in lupus nephritis, 2005-2009
Renal function by age group in lupus nephritis, 2005-2009
Renal function at presentation by gender in lupus nephritis, 2005-2009
ARA criteria in lupus nephritis by age group, 2005-2009
ARA criteria in lupus nephritis by gender, 2005-2009
ARA criteria in lupus nephritis by histopathology, 2005-2009
Extra-renal involvement by gender in lupus nephritis, 2005-2009
Mucocutaneous involvement by gender in lupus nephritis, 2005-2009
Death from SLE
Patients survival estimates for death in lupus nephritis
Renal survival estimates for lupus nephritis
Patients survival estimates for lupus nephritis
Renal survival of patients with lupus nephritis
Number of renal transplant biopsy, 2005-2009
Renal allograft biopsy by year and age group, rate per million population
2005-2009
Timing of renal allograft biopsy, 2005-2009
Biopsy method (censored for missing data), 2005-2009
Number of passes, 2005-2009
Number of glomeruli obtained on biopsy, 2005-2009
Histological diagnosis, 2005-2009
48
49
49
49
50
51
54
54
55
56
57
57
58
58
67
67
72
74
76
77
78
79
81
xvii
REPORT SUMMARY
CHAPTER 1: OVERVIEW OF RENAL BIOPSY IN MALAYSIA
The third MRRB report included data from MOH centres, Ministry of Defence, the universities and
private hospitals .
Total of 43 centres contributed data in 2009. Twenty-three centres were from MOH, 16 were from
private hospitals, 3 from universities and one from the army .
7085 renal biopsies were performed from 1st Jan 2005 until 31st Dec 2009 and of these, 4866
(68.7%) were reported.
The ascertainment rate was 62.7%, 61.0%, 73.8%, 75.7% and 69.3% for the years 2005, 2006,
2007, 2008 and 2009 respectively
Average ascertainment rate for the years 2005 – 2009 was 68.7%.
87.8 % of renal biopsies performed in 2009 were native biopsies.
86% of native biopsies were done in patients older than 15 years old and in this group 91.3% of
the biopsies were done in patients less than 55 years of age.
There were more females than males (ratio 3:2) due to the higher number of females amongst
patients biopsied for lupus nephritis.
1093 (22.5%) of the biopsies from 2005 to 2009 yielded less than 10 glomeruli.
72 (1.5%) of biopsies were classified as missing. The histopathological reports were not submitted
to MRRB.
Histopathology slides were read by pathologists in the same hospital in 48.5 % of the cases and
51.5% were read by pathologists in another hospital.
Main indications for native kidney biopsies were nephrotic syndrome (45%) and urinary
abnormalities (28%).
In those requiring a native kidney biopsy, 53 % had normal renal function and 34% had impaired
renal function at the time of biopsy. Data was missing for 13%.
CHAPTER 2: PRIMARY GLOMERULONEPHRITIS
The commonest primary GN reported was Minimal Change Disease (MCD) followed by Focal
Segmental Glomerulosclerosis (FSGS) .
Minimal change disease
Accounted for 33.4% of total primary GN.
Mean age at the time of biopsy was 29.2 ± 12.9 years .
Male to female ratio was 2:1.
Nephrotic syndrome was the most common clinical presentation.
Twenty percent had e-GFR < 60 ml/min/1.73 m2 at time of biopsy
There was a higher risk of renal impairment with increasing age.
xviii
REPORT SUMMARY
con’t
Focal Segmental Glomerulosclerosis (FSGS)
Accounted for 29.3% of total primary GN.
Mean age at the time of biopsy was 33.2 ± 14.1 years .
Male to female ratio was 1.3:1.
Nephrotic syndrome was the most common clinical presentation.
Forty-nine percent had e-GFR < 60 ml/min/1.73 m2 at time of biopsy
There was a higher risk of renal impairment with increasing age
Idiopathic Membranous Nephropathy (IMN)
Accounted for 9.8% of total primary GN.
Mean age at the time of biopsy was 44.9 + 15.0 years .
Male to female ratio was 1.2:1.
Nephrotic syndrome was the most common clinical presentation.
Thirty-seven percent had e-GFR < 60 ml/min/1.73 m2 at time of biopsy .
There was a higher risk of renal impairment with increasing age
IgA nephropathy
Accounted for 19.6% of total primary GN.
Mean age at the time of biopsy was 33.1 ± 12.5 years.
Male to female ratio was 0.9:1.
Asymptomatic urine abnormalities was the most common clinical presentation, followed by
nephritic syndrome.
Forty-six percent had e-GFR < 60 ml/min/1.73 m2 at time of biopsy.
Males tend to have worse renal function at presentation compared to females.
CHAPTER 3: SECONDARY GLOMERULONEPHRITIS
The commonest secondary GN reported was lupus nephritis. Diabetic nephropathy was the second
commonest glomerular disease reported.
Lupus nephritis
Accounted for 85% of total secondary GN.
Mean age at the time of biopsy in adult lupus nephritis was 30.2 ± 10.4 years.
Male to female ratio was 7.5:1.
Urine abnormality (36%) was the commonest clinical presentation followed by nephrotic
syndrome (31%).
The commonest histopathological finding was WHO or ISN/RPS class IV or IV+V (58%).
There was no clear correlation between histopathological findings and clinical presentation.
However, class IV or class IV+V were more likely to present with symptomatic renal disease.
The prevalence of hypertension was higher in class IV or class IV +V
The prevalence of impaired kidney function correlated with histopathological findings. Class IV
was more likely to have impaired renal function.
About 2/3 of cases with lupus nephritis fulfilled 4 or more American Rheumatological Association
(ARA) criteria at presentation.
Fulfilling the ARA criteria does not predict the severity of renal lesion.
xix
REPORT SUMMARY
con’t
CHAPTER 4: PAEDIATRIC RENAL BIOPSY
This chapter reports on renal biopsy in children less than 15 years of age and the summary details the
report for the years 1999 -2009.
809 renal biopsies were performed in 755 children.
944 renal biopsies were performed in 879 children.
Majority of biopsies were performed in MOH hospitals.
900 (95.3%) were assessed to be adequate. The success rate is comparable to reports from
Thailand, UK and Japan.
729(77.7%) yielded more than 10 glomeruli.
51.5% were performed in girls.
Nephrotic syndrome (52.5%) was the most frequent clinical presentation.41.4% of the diagnosis
on biopsy was FSGS and minimal change disease in 28.4%.
The commonest biopsy finding for nephritic syndrome was post-infectious glomerulonephritis
(35.1%).
Overall, in terms of diagnosis on biopsies for the paediatric age group, lupus nephritis was the
commonest finding in 25.2%, followed closely by FSGS (24.8%) and MCD accounted for 18.1%.
There were no differences in terms of age at presentation, race, gender, urine albumin excretion
and creatinine clearance in children with FSGS and minimal change disease at biopsy.
There was no difference in patient survival for FSGS and minimal change disease.
Commonest biopsy finding for the lupus group was class IV and Class V + IV (64.6%).
Renal survival for the lupus group was 95.8% and 92.7% at 3 and 5 years.
The complication rate for renal biopsy was 5.1%. The most common complication was bleeding
which occurred in 3.6 %.
CHAPTER 5: RENAL ALLOGRAFT BIOPSY
This chapter reports on renal allograft biopsy and the summary details the report for the years 2004 2008.
The number of renal allograft biopsies doubled over the last 5 years despite a decreased in the
number of new transplant recipients.
This was largely contributed by an increase in participating centres reporting to MRRB.
The biopsies were usually performed in the age group 15 to 54 years.
Acute and chronic allograft dysfunction was the commonest indications.
In addition, there was a marked increase in the number of renal allograft biopsies performed after
one year post transplant. (49.3% in 2005 and 59.7% in 2009).
73.3% of biopsies were performed under real time ultrasound guidance. However, data was
missing in 26.3% of cases.
Complications were reported in 2.7% of the biopsies.
The histological diagnosis on biopsy in order of importance was acute rejection (36.9%),
calcineurin inhibitor toxicity (16%), chronic allograft nephropathy (14.7%) and acute tubular
necrosis (13.7%).
xx
3rd Report of the
Malaysian Registry of Renal Biopsy 2009
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
CHAPTER 1
Overview Of Renal Biopsy In Malaysia
Wa Sha’ariah Md Yusuf
Lee Ming Lee
Lee Day Guat
1
3rd Report of the
Malaysian Registry of Renal Biopsy 2009
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
1.1: Introduction
Since the establishment of the Malaysian Registry of Renal Biopsy (MRRB) on 1st January 2005 we had
successfully had two publications. The first MRRB Report 2007 was published in 2009 and the report
provided data of renal biopsy performed and reported for year 2005 to 2007 from most of the centres
providing nephrology services in the Ministry of Health (MOH). The second MRRB Report 2008 was
published in 2010 and it included data from MOH centres, universities and private hospitals. This third
MRRB Report 2009 will include renal biopsies performed in all participating centres in MOH centres,
universities and private hospitals from 2005-2009 onwards .Previous incomplete data from several
centres from the years 2005 to 2008 are included in this third report.
The MRRB has thus far come up with publications of updated data two years behind time. We hope in
future the MRRB will be able to publish the data in the next immediate year like our Malaysian Dialysis
and Transplant Registry.
1.2: Renal biopsies from the participating centres
1.2.1: Ascertainment rate of total biopsy performed
There were a total of 43 participating centres from 2005 to 2009: 23 centres (15 adult and 8 paediatric)
were from Ministry of Health (MOH), 16 were from private hospitals, 3 were from universities and 1
from Ministry of Defence. All participating centres will be identified by their individual source document
provider (SDP) number.
A total of 7085 biopsies were done since 2005 and of these 4866(68.7%) were reported. The
ascertainment rate was 62.7% for 2005, 61.0% for 2006, 73.8% for 2007, 75.7% for 2008 and 69.3% in
2009. The average ascertainment rate for 2005-2009 was 68.7%. The changes in the ascertainment rates
compared to previous reports was due to the increased number of unreported cases of biopsies
performed in the new participating centres. Some centres had voluntarily agreed to participate in the
data submission, however failed to provide the data required. There could be many factors contributing
to failure of data submission but a major factor could be due to the heavy workload among the
nephrologists.
Table 1.2.1(a): Total number of reported and unreported renal biopsies by centres, 2005-2009
Year
2005
Reported
2006
2007
2008
2009
Total
Not
Not
Not
Not
Not
Not
Reported
Reported
Reported
Reported
Reported
reported
reported
reported
reported
reported
reported
Centre
n
n
n
n
n
n
n
n
n
n
n
n
180
97
0
107
0
101
0
120
3
139
12
564
15
380
2
0
10
1
25
0
84
1
89
0
210
2
480
97
3
104
0
65
0
55
2
51
0
372
5
481
13
0
18
0
19
0
18
0
19
0
87
0
580
28
27
38
7
44
6
3
0
0
0
113
40
680
0
30
0
0
0
0
0
0
0
0
0
30
780
31
4
45
3
55
1
50
0
60
0
241
8
880
26
1
28
1
24
0
24
0
13
0
115
2
881
10
3
5
0
11
0
11
0
6
0
43
3
980
21
1
27
0
21
0
22
0
33
1
124
2
1080
68
0
81
0
61
0
94
0
88
0
392
0
2
3rd Report of the
Malaysian Registry of Renal Biopsy 2009
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
Table 1.2.1(a): Total number of reported and unreported renal biopsies by centres, 2005-2009 (cont.)
Year
2005
Reported
2006
2007
2008
2009
Total
Not
Not
Not
Not
Not
Not
Reported
Reported
Reported
Reported
Reported
reported
reported
reported
reported
reported
reported
Centre
n
n
n
n
n
n
n
n
n
n
n
n
1180
0
11
42
21
4
28
31
1
30
6
107
67
1181
0
0
2
0
7
1
0
7
0
13
9
21
1280
18
3
6
27
10
15
4
23
11
0
49
68
1380
15
0
24
0
31
1
26
11
11
5
107
17
1480
39
0
50
0
44
0
0
0
3
89
136
89
1780
74
0
101
0
63
0
87
0
75
0
400
0
2081
42
0
51
0
42
0
55
0
43
0
233
0
4380
91
4
141
0
109
12
112
14
155
1
608
31
4381
16
0
24
2
14
0
16
0
12
2
82
4
7781
28
0
24
0
37
0
41
0
26
0
156
0
20080
0
0
0
84
0
62
0
179
0
80
0
405
20180
0
193
0
239
176
0
151
28
50
128
377
588
20280
0
0
0
15
0
22
0
25
1
18
1
80
25280
4
0
2
0
4
0
2
0
2
0
14
0
60680
0
10
0
12
1
7
12
0
6
11
19
40
60980
0
0
0
9
0
12
0
12
7
3
7
36
61080
0
0
7
6
1
22
4
24
4
16
16
68
61280
1
36
0
52
0
32
4
20
10
7
15
147
61780
0
12
0
6
0
4
0
10
0
0
0
32
61880
0
20
0
20
0
20
0
0
5
7
5
67
62380
0
48
0
45
2
62
55
10
64
0
121
165
62580
0
1
0
3
0
2
2
0
3
0
5
6
65480
0
9
0
8
0
10
0
0
0
0
0
27
65780
0
0
0
0
0
8
3
0
1
1
4
9
65880
0
13
0
8
0
18
17
0
5
0
22
39
68580
0
0
0
0
0
0
19
0
16
0
35
0
106881
0
0
0
0
3
0
17
0
6
0
26
0
108180
0
0
0
29
0
0
37
7
0
69
37
105
114580
0
0
0
0
0
1
0
0
0
0
0
1
121580
0
0
0
0
0
0
0
0
0
0
0
0
126080
0
0
0
0
0
0
0
0
5
0
5
0
127780
0
0
0
0
0
0
0
0
9
0
9
0
721
429
937
598
974
346
1176
377
1058
469
4866
2219
Total
3
3rd Report of the
Malaysian Registry of Renal Biopsy 2009
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
Table 1.2.1(b): Total number of reported and unreported renal biopsies, 2005-2009
Year
2005
2006
2007
2008
2009
Total
Reported
721
937
974
1176
1058
4866
Not reported
429
598
346
377
469
2219
Total performed
1150
1535
1320
1553
1527
7085
Ascertainment rate (%)
62.7
61.04
73.79
75.72
69.29
68.68
1.2.2: Type of renal biopsy performed
As expected, majority of the biopsies reported were from native kidneys: 90.2% in 2005, 87.4% in 2006,
87.3% in 2007, 89.5% in 2008 and 87.8% in 2009. Overall, 88.4% of renal biopsies were from native
kidneys while 11.6% were from graft kidneys (Table 1.2.2).
Table 1.2.2: Distribution of reported native and graft renal biopsies by centres, 2005-2009
2005
4
2006
2007
2008
2009
Total
Native
Graft
Native
Graft
Native
Graft
Native
Graft
Native
Graft
Native
Graft
Centre
n
n
n
n
n
n
n
n
n
n
n
n
180
69
28
57
50
58
43
83
37
99
40
366
198
380
2
0
10
0
25
0
81
3
86
3
204
6
480
85
12
93
11
63
2
51
4
49
2
341
31
481
13
0
17
1
19
0
18
0
19
0
86
1
580
27
1
36
2
42
2
3
0
0
0
108
5
680
0
0
0
0
0
0
0
0
0
0
0
0
780
26
5
34
11
43
12
40
10
51
9
194
47
880
26
0
27
1
23
1
23
1
11
2
110
5
881
10
0
5
0
11
0
11
0
6
0
43
0
980
21
0
25
2
20
1
21
1
33
0
120
4
1080
68
0
79
2
61
0
93
1
87
1
388
4
1180
0
0
42
0
4
0
31
0
30
0
107
0
1181
0
0
2
0
7
0
0
0
0
0
9
0
1280
18
0
6
0
10
0
4
0
11
0
49
0
1380
15
0
24
0
31
0
26
0
10
1
106
1
1480
35
4
47
3
44
0
0
0
3
0
129
7
1780
72
2
99
2
61
2
82
5
72
3
386
14
2081
41
1
38
13
33
9
38
17
31
12
181
52
4380
73
18
122
19
87
22
97
15
112
43
491
117
4381
16
0
23
1
14
0
16
0
12
0
81
1
7781
28
0
24
0
37
0
39
2
25
1
153
3
20080
0
0
0
0
0
0
0
0
0
0
0
0
20180
0
0
0
0
146
30
124
27
43
7
313
64
3rd Report of the
Malaysian Registry of Renal Biopsy 2009
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
Table 1.2.2: Distribution of reported native and graft renal biopsies by centres, 2005-2009 (cont.)
2005
2006
2007
2008
2009
Total
Native
Graft
Native
Graft
Native
Graft
Native
Graft
Native
Graft
Native
Graft
Centre
n
n
n
n
n
n
n
n
n
n
n
n
20280
0
0
0
0
0
0
0
0
1
0
1
0
25280
4
0
2
0
4
0
2
0
2
0
14
0
60680
0
0
0
0
1
0
12
0
6
0
19
0
60980
0
0
0
0
0
0
0
0
7
0
7
0
61080
0
0
7
0
1
0
4
0
4
0
16
0
61280
1
0
0
0
0
0
4
0
10
0
15
0
61780
0
0
0
0
0
0
0
0
0
0
0
0
61880
0
0
0
0
0
0
0
0
5
0
5
0
62380
0
0
0
0
2
0
55
0
64
0
121
0
62580
0
0
0
0
0
0
2
0
3
0
5
0
65480
0
0
0
0
0
0
0
0
0
0
0
0
65780
0
0
0
0
0
0
3
0
1
0
4
0
65880
0
0
0
0
0
0
16
1
5
0
21
1
68580
0
0
0
0
0
0
19
0
16
0
35
0
106881
0
0
0
0
3
0
17
0
6
0
26
0
108180
0
0
0
0
0
0
37
0
0
0
37
0
114580
0
0
0
0
0
0
0
0
0
0
0
0
121580
0
0
0
0
0
0
0
0
0
0
0
0
126080
0
0
0
0
0
0
0
0
0
5
0
5
127780
0
0
0
0
0
0
0
0
9
0
9
0
650
71
819
118
850
124
1052
124
929
129
4300
566
Total
5
3rd Report of the
Malaysian Registry of Renal Biopsy 2009
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
1.2.3: Number of renal biopsy done on each individual patient
The data captured in MRRB is year based. New biopsies and patients biopsied before 2005 were
included. The number of biopsy episodes/attempts per patient was also recorded accordingly.
In the native biopsy group, from 2005 to 2009, a total of 4238 patients underwent renal biopsy. 3684
patients had renal biopsy for the first time, 457 patients had biopsy done twice, 84 patients had biopsy
done thrice and 13 patients had four or more biopsies. Therefore about 13.1% of patients had a repeat
native biopsy. (Table 1.2.3(a)).
In the allograft biopsy group; over the same period, 462 patients underwent a graft biopsy. 283 patients
had biopsy done once, 116 patients had biopsy done twice, 40 patients had biopsy done thrice and 23
patients had biopsy done four times or more (Table1.2.3 (b)). As expected, there was a higher rate of
repeat graft biopsies (38.7 %).
Table 1.2.3(a): Distribution of native renal biopsy in patients by number of episodes, 2005-2009
Native
2005
2006
2007
2008
2009
Total
n
%
n
%
n
%
n
%
n
%
n
st
1 episode
560
87
703
87
728
87
913
88
780
86
3684
2nd
72
11
96
12
84
10
106
10
99
11
457
3rd
10
2
9
1
25
3
15
1
25
3
84
≥4th
1
0
0
0
3
0
3
0
6
1
13
643
100
808
100
840
100
1037
100
910
100
4238
Total Patient
Table 1.2.3(b): Distribution of renal allograft biopsy in patients by number of episodes/attempts,
2005-2009
Graft
6
2005
2006
2007
2008
2009
Total
n
%
n
%
n
%
n
%
n
%
n
1st episode
48
77
70
69
60
63
54
52
51
50
283
2nd
11
18
21
21
22
23
32
31
30
30
116
3rd
3
5
7
7
9
9
10
10
11
11
40
>4th
0
0
3
3
4
4
7
7
9
9
23
Total Patient
62
100
101
100
95
100
103
100
101
100
462
3rd Report of the
Malaysian Registry of Renal Biopsy 2009
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
1.2.4: Demographic distribution of renal biopsy (Native and Graft)
1.2.4.1: Age distribution
Eighty four percent of native biopsies were done in patients older than 15 years old and in this group,
92% of the biopsies were done in patients less than 55 years age. Very few (8%) biopsies were done in
patients older than 55 years old (Table 1.2.4.1 (a)).
In the graft biopsy group, 89% were done in patients older than 15 years old and of these, 84% were in
the age group of 15 to less than 55 years. Only 11% of the graft biopsies were done in those above 55
years of age (Table 1.2.4.1(b)).
For adults (age >15years old) the highest number of renal biopsy was reported in Wilayah Persekutuan
Kuala Lumpur (34%), followed by Selangor (20%) and Penang (8%). In the paediatric group (age
the MALAYSIAN REGISTRY of
RENAL BIOPSY 2009
Editors:
Rosnawati Yahya
Wan Jazilah Wan Ismail
With contributions from:
Wan Shaariah, Sunita B, Yap Y C, Wong H S, Lee DG, Lim J Y, Premaa S, Tassha H A
Malaysian Society of Nephrology
Ministry of Health Malaysia
3rd REPORT OF
THE MALAYSIAN REGISTRY
of
RENAL BIOPSY
2009
Sponsors:
Malaysian Society of Nephrology
The National Renal Registry is funded with grants from:
The Ministry of Health Malaysia
Roche
Ain Medicare
Baxter Healthcare
Fresenius Medical Care
i
December 2011
© National Renal Registry, Malaysia
ISSN 1985-6989
Published by:
The National Renal Registry
Malaysian Society of Nephrology
Suite 1604, Plaza Permata
No. 6, Jalan Kampar
50400 Kuala Lumpur
Malaysia
Telephone. : (603) 4045 8636
Direct Fax : (603) 4042 7694
: nrr@msn.org.my
Web site : http://www.msn.org.my
Cover illustration by Dr. Nik Hasimah Nik Yahya HKL
Important information:
This report is copyrighted. However it may be freely reproduced without the permission of the
National Renal Registry. Acknowledgment would be appreciated. Suggested citation is:
Rosnawati Yahya, Wan Jazilah W I (Eds) First Report of the Malaysian Registry of Renal Biopsy.
Kuala Lumpur 2008
This report is also published electronically on these websites http://www.msn.org.my or https://
www.macr.org.my/emrrb .
ii
ACKNOWLEDGEMENTS
The National Renal Registry would like to thank the following:
All the nephrologists and staff of the participating hospitals
For their hard work and contribution,
The Ministry of Health, Malaysia
for support seen and unseen,
For their generous support: Roche
Ain Medicare
Baxter Healthcare
Fresenius Medical Care
The staff of the Clinical Research Centre
&
All who have in one way or another supported the National Renal
Registry.
iii
NRR ADVISORY COMMITTEE MEMBERS
2010 TO 2012
Members:
MSN appointment:
Facilities
Datuk Dr. Ghazali Ahmad
Chairman
Hospital Kuala Lumpur
Dr. Abdul Halim Abd Gafor
University representative
Dr. Goh Bak Leong
MINR sub-committee Chairperson
University Kebangsaan
Malaysia Medical Centre
Hospital Serdang
MDTR advisor
Independent Consultant
Nephrologist
MDTR sub-committee Chairperson
Hospital Kuala Lumpur
Dr. Ong Loke Meng
CRC representative
Hospital Penang
Dr. Rafidah Abdullah
Honorary MSN Treasurer
Hospital Selayang
Dr. S. Prasad Menon
Private sector representative
Sime Darby Medical
Centre Subang Jaya
Hospital Selayang
Dr. Lim Teck Onn
Dr. Lim Yam Ngo
Dr. Wong Hin Seng
eMOSS sub-committee Chairperson
Dato' Dr. Wan Shaariah Md Yusuf
MRRB sub-committee Chairperson
Tuanku Ja'afar Hospital
Dato' Dr. Zaki Morad B Mohd Zaher
NGO representative
National Kidney
Foundation
Mr. Husin Harun
ADMAN representative
Hospital Kuala Lumpur
Clinical Registry Manager
Lee Day Guat
Clinical Research Assistant
Suhazelini Ali
Choo Cheh Loo
Statistician
Premaa A/P Supramaniam
Tassha Hilda binti. Adnan
Adam bin Bujang
MRRB WORKING COMMITTEE MEMBERS
Chairperson
Dato’ Dr. Wa Sha’ariah Md Yusuf
Co-Chairperson
Members
Dr. Rosnawati Yahya
Dr. Lim Soo Kun
Dr. Sunita Bavanandan
Dr. Wan Jazilah Wan Ismail
Dr. Wong Hin Seng
Dr. Yap Yoke Chin
iv
ABOUT MALAYSIAN REGISTRY OF RENAL BIOPSY
Renal biopsy remains the main investigation in the diagnosis of renal diseases. In addition, it plays a
major role in determining the management and prognosis of parenchymal renal disease. The
collection of demographic, clinical and laboratory data at the time of biopsy and the set up of a
database are useful tools for studying renal parenchymal diseases.
The development of a renal biopsy registry in each country promotes many advantages and these
include comparison in incidence of renal diseases, identification of different policies and practices in
renal biopsy in different areas, linkage with other registries such as dialysis or transplant registry and
identification of rare renal diseases. Thus, the registry is a source of epidemiological data and would
provide useful information in the planning of health care and in organizing prospective clinical studies.
The incidence of glomerular disease varies according to population, demographic characteristics,
environmental factors, socio-economic status and the prevalence of infectious diseases. At present,
there is limited information on the prevalence and incidence of glomerular disease, its potential
disease burden and the temporal trend in Malaysia. Hence, the Malaysian Registry of Renal Biopsy
(MRRB) was set up in 2005 to address this deficiency.
The MRRB collects information about patients who undergo renal biopsy in Malaysia. The MRRB is a
new component of National Renal Registry (NRR), which has been operating the Malaysian Dialysis
and Transplant Registry (MDTR) since 1993.
Objectives
The objectives of the MRRB registry are to:
1. Determine the disease burden attributable to glomerular disease (GD) by quantifying its incidence
and prevalence, and its geographic and temporal trends in Malaysia.
2. Identify subgroups in the population at high risk of GD to whom preventive efforts should be
targeted.
3. Identify potential causal and risk factors involved in GD.
4. Describe the clinical presentation and spectrum of GD.
5. Stimulate and facilitate basic, clinical and epidemiological research on GD.
6. Identify causes of allograft failure in our renal transplant population.
7. To audit the renal biopsy procedure, monitor both complications and quality of specimens in
addition to identifying risk factors associated with complications.
v
Organization
The NRR organization is as follows:
Owner
(MSN)
Sponsors
(MSN & MOH)
NRR Advisory
Committee
MRRB
Steering
Committee
NRR co-coordinating office
Source Data Providers
Target groups or Users
Owner
The Malaysian Society of Nephrology (MSN) is the owner of this registry.
Sponsors
The MRRB is sponsored by the Malaysian Society of Nephrology (MSN) and the Ministry of Health,
Malaysia.
NRR Advisory Committee
This is the o
ittee esta lished y the spo sors. The NRR Advisory Co
ittee’s role is to e sure
that the MRRB stay focused on its objectives and to assure its continuing relevance and justification.
MRRB Steering Committee
The MRRB Working Committee supervises its operations.
National Renal Registry office
The NRR coordinating office is the designated coordinating center. It coordinates the data collection
among the Source Data Providers (SDPs). It collaborates with Clinical Research Centre of Hospital
Kuala Lumpur that provides epidemiological and statistical support for MRRB.
Source Data Providers (SDP)
These are centres that contribute the required data for MRRB. The SDP collects and enters data
directly through the on-line web-base system. The pilot phase of the registry consists of SDPs from
Ministry of Health.
Throughout this initial phase, we have refined and improved the database. In 2008, the registry is
expanding to a national level to include participation from all nephrologists and renal physicians in
Malaysia who perform renal biopsies. We hope the nephrology community will support us by
submitting information, which is crucial to eventually improve the management of patients with
Chronic Kidney Disease (CKD).
vi
To participate in MRRB
Centres interested to participate in this registry please write in to NRR officially via post or email
nrr@msn.org.my.
The following documents need to be completed and returned to facilitate participation.
Centre Participation Self Reply Form
Authorization Form
Information Security Policy/User Agreement . One form per nominee as listed in the Authorization
form. Users must have a personal mobile phone to received SMS authentication.
Upon receiving these documents, the centre shall be registered and each of the users of the MRRB
shall be notified via their e-mail address.
Methodology
All patients from participating centres who undergo any kidney biopsy (native or graft) are to be
enrolled into the registry.
On-line data submission is through MRRB web application or paper CRF. The data variables collected
include demography, clinical presentation, and indication of biopsy, renal function, and laboratory
data at presentation and at the time of biopsy, serological markers, virology status and
histopathological result. In addition, an update on outcomes in terms of significant end-points such as
end stage renal disease or death will be recorded annually.
vii
DATA CONTRIBUTING CENTRES
Adult Centre Name
Sector
96 Hospital Angkatan Tentera Lumut
Hospital Pakar Sultanah Fatimah Muar
Kuala Lumpur Hospital
Melaka Hospital
Pulau Pinang Hospital
Queen Elizabeth Hospital
Raja Perempuan Zainab II Hospital
Raja Permaisuri Bainun Hospital
Sarawak General Hospital
Selayang Hospital
Serdang Hospital
Sultanah Aminah Hospital
Sultanah Bahiyah Hospital
Sultanah Nur Zahirah Hospital
Tengku Ampuan Afzan Hospital
Tengku Ampuan Rahimah Hospital
Tuanku Ja'afar Hospital
Fan Medical Renal Clinic
Ipoh Specialist Hospital
KPJ Ampang Puteri Specialist Hospital
KPJ Selangor Specialist Hospital
Lam Wah Ee Hospital
Metro Specialist Hospital
Normah Medical Specialist Centre
Prince Court Medical Centre
Sunway Medical Centre
Teo Kidney Specialist Clinic
Timberland Medical Centre
Tung Shin Hospital
University Malaya Medical Centre
Universiti Sains Malaysia Hospital
All
Armed forces
MOH
MOH
MOH
MOH
MOH
MOH
MOH
MOH
MOH
MOH
MOH
MOH
MOH
MOH
MOH
MOH
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
University
University
Paediatric Centre Name
Sector
Kuala Lumpur Hospital
Likas Hospital
Pulau Pinang Hospital
Selayang Hospital
Sultan Ismail Hospital
Tengku Ampuan Afzan Hospital
Tuanku Ja'afar Hospital
All
MOH
MOH
MOH
MOH
MOH
MOH
MOH
viii
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1st Report
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2nd Report
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3rd Report
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6
CONTRIBUTING EDITORS
Chapter
1
2
Title
Authors
Institutions
Overview of Renal Biopsy in
Malaysia
Wa Sha’ariah Md Yusuf
Tua ku Ja’afar Hospital
Lee Ming Lee
Tua ku Ja’afar Hospital
Lee Day Guat
National Renal Registry
Sunita Bavanandan
Kuala Lumpur Hospital
Lim Soo Kun
University Malaya Medical
Centre
Primary Glomerulonephritis
3
Secondary Glomerulonephritis
Rosnawati Yahya
Kuala Lumpur Hospital
4
Paediatric Renal Biopsy
Lee Ming Lee
Tua ku Ja’afar Hospital
Lim Yam Ngo
Kuala Lumpur Hospital
Lynster Liaw
Pulau Pinang Hospital
Susan Pee
Sultan Ismail Hospital
Wan Jazilah Wan Ismail
Selayang Hospital
Yap Yoke Chin
Kuala Lumpur Hospital
Selvakumar Sivapunniam
Tengku Ampuan Afzan Hospital
Wong Hin Seng
Selayang Hospital
5
Renal Allograft Biopsy
Report Editors
Rosnawati Yahya
Wan Jazilah Wan Ismail
ix
CONTENTS
x
CHAPTER 1
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
1.1
Introduction
1.2
Renal biopsies from the participating centres
1.2.1
Ascertainment rate of total biopsy performed
1.2.2
Type of renal biopsy performed
1.2.3
Number of renal biopsy done on each individual patient
1.2.4
Demographic distribution of renal biopsy (Native and Graft)
1.2.4.1 Age distribution
1.2.4.2 Gender distribution
1.2.4.3 Racial distribution
1.2.5
Renal biopsy report analysis
1.2.6
Histopathology specimen distribution to histopathology laboratories
1.3
Native kidney biopsy
1.3.1
Clinical Indications of renal biopsy
1.3.2
Histopathological diagnosis
1.3.3
Histopathology findings in common clinical presentation
1.3.3.1 Histopathological diagnosis in patients with nephrotic syndrome
1.3.3.2 Histopathological diagnosis in patients with urinary abnormalities
1.3.3.3 Histopathological diagnosis in patients with nephritic-nephrotic
syndrome
1.3.3.4 Histopathological diagnosis in patients with nephritic syndrome
1.3.3.5 Primary GN according to various age group
1
2
2
2
4
6
7
7
9
9
10
11
14
14
14
17
17
18
CHAPTER 2
PRIMARY GLOMERULONEPHRITIS
2.1
Introduction
2.2
Minimal Change Disease
2.2.1
Introduction
2.2.2
Patient population and characteristics
2.2.3
Clinical presentation
2.2.3.1 Clinical presentation by age
2.2.3.2 Clinical presentation by gender
2.3
Focal Segmental Glomerulosclerosis
2.3.1
Introduction
2.3.2
Patient population and characteristics
2.3.3
Clinical Presentation
2.3.3.1 Clinical presentation by age
2.3.3.2 Clinical presentation by gender
2.4
Idiopathic Membranous Nephropathy
2.4.1
Introduction
2.4.2
Patient population and characteristics
2.4.3
Clinical presentation
2.4.3.1 Clinical Presentation by age
2.4.3.2 Clinical presentation by gender
23
24
24
24
25
26
27
28
29
29
29
30
31
32
33
33
33
34
35
36
19
20
21
CONTENT
2.5
con’t
IgA Nephropathy (IgAN)
2.5.1
Introduction
2.5.2
Patient population and characteristics
2.5.3
Clinical presentation
2.5.3.1
Clinical presentation by age
2.5.3.2
Clinical presentation by gender
CHAPTER 3
SECONDARY GLOMERULONEPHRITIS
3.1
Introduction
3.2
Lupus Nephritis
3.2.1
Introduction
3.2.2
Patient population and characteristics
3.2.2.1
Age at time of biopsy
3.2.2.2
Gender distribution
3.2.2.3
Racial prevalence
3.2.3
Clinical presentation
3.2.3.1
Clinical Presentation by age
3.2.3.2
Clinical presentation by gender
3.2.3.3
Clinical Presentations by histopathology
3.2.4
Renal function at presentation
3.2.4.1
Renal function at presentation by age group
3.2.4.2
Renal function at presentation by gender
3.2.4.3
Renal function at presentation by histopathology
3.2.5
Histopathological diagnosis
3.2.5.1
Histopathological diagnosis by age
3.2.5.2
Histopathological diagnosis by gender
3.2.5.3
Histopathological diagnosis by clinical presentation
3.2.6
Extra-renal involvement
3.2.6.1
American Rheumatological Association (ARA) criteria in lupus
nephritis
3.2.6.2
ARA criteria in lupus nephritis by age
ARA criteria in lupus nephritis by gender
3.2.6.3
3.2.6.4
ARA criteria in lupus nephritis by histopathological findings
3.2.6.5
Extra-renal involvement
3.2.7
Survival in lupus nephritis
3.2.7.1
Patient survival in lupus nephritis
Renal survival in lupus nephritis
3.2.7.2
CHAPTER 4
PAEDIATRIC RENAL BIOBSY
4.1
Introduction
4.2
Number of patients and renal biopsies
4.2.1
Total number of patients and native renal biopsies
4.2.2
Number of patients from various hospitals
4.2.3
Number of native renal biopsies
37
37
37
38
39
39
43
44
44
44
44
45
46
46
47
48
49
50
50
51
51
52
52
52
53
54
54
54
54
55
56
57
57
58
59
60
60
60
60
60
xi
CONTENT
4.3
4.4
4.5
4.6
4.7
4.8
4.9
4.10
4.11
con’t
Outcome of renal biopsies
4.3.1
Adequacy of renal biopsy for diagnosis
4.3.2
Number of glomeruli obtained at each biopsy
Patient characteristics
Clinical presentation
4.5.1
Clinical presentation at biopsy
Histopathological findings of paediatric renal biopsies
4.6.1
Diagnosis of paediatric renal biopsies
4.6.2 Annual frequency of main renal biopsy findings
Renal histopathology diagnosis of children presenting with nephrotic syndrome
Renal histopathology diagnosis of children presenting with nephritic syndrome
Paediatric lupus nephritis
4.9.1
Patient characteristics of paediatric lupus nephritis
4.9.2
Extra renal manifestations of paediatric SLE
4.9.3
Clinical presentation at biopsy (SLE)
4.9.4
Classification of paediatric lupus nephritis
4.9.5
Paediatric Patient survival in lupus nephritis
4.9.6
Renal survival of paediatric patients with lupus nephritis
Renal outcome
Biopsy failure and complications
61
61
61
61
62
62
62
62
62
64
64
65
65
66
66
66
67
67
68
68
References
CHAPTER 5
RENAL ALLOGRAFT BIOPSY
5.1
Introduction
5.2
Number of renal allograft biopsy
5.2.1
Number of renal allograft biopsy by year
5.2.2
Number of renal allograft biopsy by year and site
5.2.3
Number of renal allograft biopsy by year and age group
5.3
Clinical presentation at biopsy
5.4
Timing of renal allograft biopsy
5.5
Renal allograft biopsy Procedure
5.5.1
Renal allograft Biopsy method
5.5.2
Number of passes
5.5.3
Number of glomeruli obtained on biopsy
5.5.4
Type of complications
5.6
Histological diagnosis
Appendix I
Appendix II
Appendix III
Appendix IV
xii
71
72
72
72
72
74
75
76
77
77
78
79
80
80
83
87
91
92
LIST OF TABLES
Page
Table 1.2.1 (a)
Table 1.2.1 (b)
Table 1.2.2
Table 1.2.3 (a)
Table 1.2.3 (b)
Table 1.2.4.1 (a)
Table 1.2.4.1 (b)
Table 1.2.4.1 (c)
Table 1.2.4.2 (a)
Table 1.2.4.2 (b)
Table 1.2.4.3 (a)
Table 1.2.4.3 (b)
Table 1.2.5
Table 1.2.6 (a)
Table 1.2.6 (b)
Table 1.2.6 (c)
Table 1.3.1 (a)
Table 1.3.1 (b)
Table 1.3.2
Table 1.3.3.1
Table 1.3.3.2
Table 1.3.3.3
Table 1.3.3.4
Table 1.3.3.5
Table 2.1
Table 2.2.2 (b)
Table 2.2.3 (a)
Table 2.2.3 (b)
Table 2.2.3 (c)
Table 2.2.3.2(a)
Table 2.2.3.2 (c)
Table 2.3.2 (b)
Table 2.3.3 (a)
Total number of reported and unreported renal biopsies by centres,
2005-2009
Total number of reported and unreported renal biopsies,2005-2009
Distribution of reported native and graft renal biopsies by centres, 20052009
Distribution of native renal biopsy in patients by number of episodes,
2005-2009
Distribution of renal allograft biopsy in patients by number of episodes,
2005-2009
Age distribution of native renal biopsy, 2005-2009
Age distribution of renal allograft biopsy, 2005-2009
Age group distribution of reported renal biopsies by state, 2005-2009
Gender distribution of native renal biopsy, 2005-2009
Gender distribution of renal allograft biopsy, 2005-2009
Racial distribution of native renal biopsy, 2005-2009
Racial distribution of renal allograft biopsy, 2005-2009
Number of glomeruli obtained at each biopsy by centres, 2005-2009
Distribution of biopsy specimens to histopathology laboratories by
participating centres, 2005-2009
Summary of biopsies received by local and external laboratories, 20072009
Histopathology laboratories receiving renal biopsy specimens, 20052009
Indications for native renal biopsies, 2005-2009
Renal function at time of biopsy
Histopathology of all native renal biopsies, 2005-2009
HPE diagnosis in patients presenting with nephrotic syndrome, 20052009
HPE diagnosis in patients presenting with urine abnormalities, 20052009
HPE diagnosis in patients presenting with nephritic-nephrotic syndrome,
2005-2009
HPE diagnosis in patients presenting with nephritic syndrome, 20052009
Primary GN according to the various age group, 2005-2009
Primary Glomerulonephritis, 2005-2009
Age group at time of biopsy (years) for MCD, 2005-2009
Clinical presentation for MCD, 2005-2009
Presence of hypertension in MCD, 2005-2009
Renal function in MCD by year, 2005-2009
Clinical presentation by gender for MCD, 2005-2009
Renal function by gender for MCD, 2005-2009
Age group at time of biopsy (years) for FSGS, 2005-2009
Clinical presentation for FSGS, 2005-2009
2
4
4
6
6
7
7
8
9
9
9
9
10
11
13
13
14
14
15
17
18
19
20
21
24
25
26
26
27
28
28
29
30
xiii
LIST OF TABLES
Table 2.3.3 (b)
Table 2.3.3 (c)
Table 2.3.3.1 (a)
Table 2.3.3.2 (a)
Table 2.4.3 (a)
Table 2.4.3 (b)
Table 2.4.3 (c)
Table 2.4.3.1 (a)
Table 2.4.3.1 (c)
Table 2.4.3.2 (a)
Table 2.4.3.2 (b)
Table 2.5.3 (a)
Table 2.5.3 (b)
Table 2.5.3 (c)
Table 2.5.3.1 (a)
Table 2.5.3.1 (b)
Table 2.5.3.1 (c)
Table 2.5.3.2 (a)
Table 3.1
Table 3.2.2.1
Table 3.2.3.1 (a)
Table 3.2.3.3 (a)
Table 3.2.4.1
Table 3.2.4.3
Table 3.2.5
Table 3.2.5.1
Table 3.2.5.2
Table 3.2.5.3
Table 3.2.6.1
Table 3.2.6.4
Table 3.2.6.5 (a)
Table 3.2.6.5 (b)
Table 3.2.7.2
Table 3.2.7.3
Table 4.2.2
Table 4.2.3
Table 4.3.1
Table 4.3.2
Table 4.4.1
Table 4.4.2
Table 4.5.1
Table 4.6.1
Table 4.6.2
Table 4.7.1
xiv
con’t
Presence of hypertension in FSGS, 2005-2009
Renal function in FSGS by year, 2005-2009
Clinical presentation by age group for FSGS, 2005-2009
Clinical presentation by gender for FSGS, 2005-2009
Clinical presentation for IMN, 2005-2009
Presence of hypertension in IMN, 2005-2009
Renal function in IMN, 2005-2009
Clinical presentation by age group for IMN, 2005-2009
Renal function at presentation by age group for IMN, 2005-2009
Clinical presentation by gender for IMN, 2005-2009
Hypertension by gender for IMN, 2005-2009
Clinical presentation for IgA nephropathy, 2005-2009
Presence of hypertension in IgA nephropathy, 2005-2009
Renal function in IgA Nephropathy, 2005-2009
Clinical presentation by age group for IgA nephropathy, 2005-2009
Hypertension by age group for IgA nephropathy, 2005-2009
Renal function at presentation by age group for IgA nephropathy, 20052009
Clinical presentation by gender for IgA nephropathy, 2005-2009
Causes of secondary glomerulonephritis in adult, 2005-2009
Age group at time of biopsy (years), 2005-2009
Clinical presentation by age group, 2005-2009
Clinical presentations by histopathology in lupus nephritis, 2005-2009
Renal function by age group in lupus nephritis, 2005-2009
Renal function at presentation by histopathology, 2005-2009
Histopathological diagnosis in lupus nephritis by year, 2005-2009
Histopathological diagnosis by age group in lupus nephritis, 2005-2009
Histopathological diagnosis by gender in lupus nephritis, 2005-2009
Histopathological diagnosis by clinical presentation in lupus nephritis,
2005-2009
ARA criteria in lupus nephritis, 2005-2009
ARA criteria by histopathology, 2005-2009
Extra-renal involvement by gender, 2005-2009
Mucocutaneous involvement by gender in lupus nephritis, 2005-2009
Patients survival estimates for death in lupus nephritis
Renal survival estimates for lupus nephritis
Number of patients from various hospitals
Number of renal biopsies
Conclusive report
Number of glomeruli obtained at each biopsy
Gender and racial distribution
Age distribution
Clinical presentation at biopsy
Diagnosis of paediatric renal biopsies
Annual frequency of the main renal biopsy findings 1999-2009
Renal histopathology diagnosis of children presenting with nephrotic
syndrome
Page
30
30
31
32
34
34
34
35
35
36
36
38
38
39
39
40
40
40
44
45
47
49
50
51
52
52
53
53
54
55
56
57
58
58
60
60
61
61
61
61
62
62
63
64
LIST OF TABLES
con’t
Page
Table 4.8
Table 4.9.1 (a)
Table 4.9.2(a)
Table 4.9.2(b)
Table 4.9.3
Table 4.9.4
Table 4.9.5
Table 4.9.6
Table 4.10
Table 4.11(a)
Table 4.11(b)
Table 5.2.1
Table 5.2.2
Table 5.2.3
Table 5.3
Table 5.4
Table 5.5.1
Table 5.5.2
Table 5.5.3
Table 5.5.4
Table 5.6
Renal histopathology diagnosis of children presenting with nephritic
syndrome
Demographic characteristic of paediatric lupus nephritis
Clinical presentations of paediatric SLE
ARA criteria at presentation
Clinical presentation at biopsy (SLE)
Classification of paediatric lupus nephritis
Patients survival in lupus nephritis
Renal survival of patients with lupus nephritis
Causes of end stage renal disease in children who underwent renal
biopsy
Frequency of complications
Risk factors for complication
Number of renal allograft biopsy, 2005-2009
Number of renal allograft biopsy by centre, 2005-2009
Renal allograft biopsy by year and age group, rate (per million
population), 2005-2009
Indications for renal allograft biopsy, 2005-2009
Timing of renal allograft biopsy, 2005-2009
Biopsy method, 2005-2009
Number of passes, 2005-2009
Number of glomeruli obtained on biopsy, 2005-2009
Type of complications, 2005-2009
Histological diagnosis, 2005-2009
64
65
65
65
66
66
67
67
68
68
69
72
73
74
75
76
77
78
79
80
80
xv
LIST OF FIGURES
Figure 1.3.3.5
Figure 2.2.2 (a)
Figure 2.2.2 (b)
Figure 2.2.3 (a)
Figure 2.2.3.1 (a)
Figure 2.2.3.1 (b)
Figure 2.2.3.1 (c)
Figure 2.2.3.2 (b)
Figure 2.3.2(a)
Figure 2.3.2 (b)
Figure 2.3.3 (a)
Figure 2.3.3.1 (a)
Figure 2.3.3.1 (b)
Figure 2.3.3.1 (c)
Figure 2.3.3.2 (a)
Figure 2.3.3.2 (b)
Figure 2.3.3.2 (c)
Figure 2.4.2 (a)
Figure 2.4.2 (b)
Figure 2.4.3 (a)
Figure 2.4.3.1
Figure 2.4.3.2 (a)
Figure 2.4.3.2 (c)
Figure 2.5.2 (a)
Figure 2.5.2 (b)
Figure 2.5.3 (a)
Figure 2.5.3.1(a)
Figure 2.5.3.2 (a)
Figure 2.5.3.2 (b)
Figure 2.5.3.2 (c)
Figure 3.2.2.1
Figure 3.2.2.2
Figure 3.2.2.3
Figure 3.2.3
Figure 3.2.3 (a)
Figure 3.2.3 (b)
Figure 3.2.3.1 (a)
Figure 3.2.3.1 (b)
Figure 3.2.3.1 (c)
Figure 3.2.3.2 (a)
Figure 3.2.3.2 (b)
xvi
Primary GN according to the various age group, 2005-2009
Demographic characteristics for MCD, 2005-2009
Age at time of biopsy (years) for MCD, 2005-2009
Overall clinical presentation for MCD, 2005-2009
Clinical presentation by age group for MCD, 2005-2009
Hypertension by age group for MCD, 2005-2009
Renal function at presentation by age group for MCD, 2005-2009
Hypertension by gender for MCD, 2005-2009
Demographic characteristics for FSGS, 2005-2009
Age at time of biopsy (years) for FSGS, 2005-2009
Overall clinical presentation for FSGS, 2005-2009
Clinical presentation by age group for FSGS,2005-2009
Hypertension by age group for FSGS, 2005-2009
Renal function at presentation by age group for FSGS, 2005-2009
Clinical presentation by gender FSGS, 2005-2009
Hypertension by gender for FSGS, 2005-2009
Renal function at presentation by gender for FSGS, 2005-2009
Demographic characteristics for IMN, 2005-2009
Age at time of biopsy (years) IMN, 2005-2009
Overall clinical presentation for IMN, 2005-2009
Clinical presentation by age group for IMN 2005-2009
Clinical presentation by gender for IMN, 2005-2009
Impaired renal function by gender, 2005-2009
Demographic characteristics of patients with IgA nephropathy, 20052009
Age at time of biopsy (years) for IgA nephropathy, 2005-2009
Overall clinical presentation for IgA nephropathy, 2005-2009
Clinical presentation by age group for IgA nephropathy, 2005-2009
Clinical presentation by gender for IgA nephropathy, 2005-2009
Hypertension by gender for IgA nephropathy, 2005-2009
Impaired renal function by gender in, 2005-2009
Age group at time of biopsy (years), 2005-2009
Gender distribution in lupus nephritis, 2005-2009
Racial distribution in lupus nephritis, 2005-2009
Clinical presentation by year, 2005-2009
Hypertension by year in lupus nephritis, 2005-2009
Impaired renal function by year in lupus nephritis, 2005-2009
Clinical presentation by age group in lupus nephritis, 2005-2009
Hypertension by age group in lupus nephritis, 2005-2009
Impaired renal function by age group in lupus nephritis, 2005-2009
Clinical presentation by gender in lupus nephritis, 2005-2009
Hypertension by gender in lupus nephritis 2005-2009
Page
22
25
25
26
27
27
27
28
29
29
30
31
31
31
32
32
32
33
33
34
35
36
36
37
37
38
39
41
41
41
45
45
46
46
47
47
47
48
48
48
48
LIST OF FIGURES
Figure 3.2.3.2 (c)
Figure 3.2.3.3 (a)
Figure 3.2.3.3 (b)
Figure 3.2.3.3 (c)
Figure 3.2.4.1
Figure 3.2.4.2
Figure 3.2.6.2
Figure 3.2.6.3
Figure 3.2.6.4
Figure 3.2.6.5 (a)
Figure 3.2.6.5 (b)
Figure 3.2.7.1
Figure 3.2.7.2:
Figure 3.2.7.3
Figure 4.9.5
Figure 4.9.6
Figure 5.2.1
Figure 5.2.3
Figure 5.4
Figure 5.5.1
Figure 5.5.2
Figure 5.5.3
Figure 5.5.6
con’t
Impaired renal function by gender in lupus nephritis, 2005-2009
Clinical presentations by histopathology in lupus nephritis, 2005-2009
Hypertension by histopathology in lupus nephritis, 2005-2009
Impaired renal function by histopathology in lupus nephritis, 2005-2009
Renal function by age group in lupus nephritis, 2005-2009
Renal function at presentation by gender in lupus nephritis, 2005-2009
ARA criteria in lupus nephritis by age group, 2005-2009
ARA criteria in lupus nephritis by gender, 2005-2009
ARA criteria in lupus nephritis by histopathology, 2005-2009
Extra-renal involvement by gender in lupus nephritis, 2005-2009
Mucocutaneous involvement by gender in lupus nephritis, 2005-2009
Death from SLE
Patients survival estimates for death in lupus nephritis
Renal survival estimates for lupus nephritis
Patients survival estimates for lupus nephritis
Renal survival of patients with lupus nephritis
Number of renal transplant biopsy, 2005-2009
Renal allograft biopsy by year and age group, rate per million population
2005-2009
Timing of renal allograft biopsy, 2005-2009
Biopsy method (censored for missing data), 2005-2009
Number of passes, 2005-2009
Number of glomeruli obtained on biopsy, 2005-2009
Histological diagnosis, 2005-2009
48
49
49
49
50
51
54
54
55
56
57
57
58
58
67
67
72
74
76
77
78
79
81
xvii
REPORT SUMMARY
CHAPTER 1: OVERVIEW OF RENAL BIOPSY IN MALAYSIA
The third MRRB report included data from MOH centres, Ministry of Defence, the universities and
private hospitals .
Total of 43 centres contributed data in 2009. Twenty-three centres were from MOH, 16 were from
private hospitals, 3 from universities and one from the army .
7085 renal biopsies were performed from 1st Jan 2005 until 31st Dec 2009 and of these, 4866
(68.7%) were reported.
The ascertainment rate was 62.7%, 61.0%, 73.8%, 75.7% and 69.3% for the years 2005, 2006,
2007, 2008 and 2009 respectively
Average ascertainment rate for the years 2005 – 2009 was 68.7%.
87.8 % of renal biopsies performed in 2009 were native biopsies.
86% of native biopsies were done in patients older than 15 years old and in this group 91.3% of
the biopsies were done in patients less than 55 years of age.
There were more females than males (ratio 3:2) due to the higher number of females amongst
patients biopsied for lupus nephritis.
1093 (22.5%) of the biopsies from 2005 to 2009 yielded less than 10 glomeruli.
72 (1.5%) of biopsies were classified as missing. The histopathological reports were not submitted
to MRRB.
Histopathology slides were read by pathologists in the same hospital in 48.5 % of the cases and
51.5% were read by pathologists in another hospital.
Main indications for native kidney biopsies were nephrotic syndrome (45%) and urinary
abnormalities (28%).
In those requiring a native kidney biopsy, 53 % had normal renal function and 34% had impaired
renal function at the time of biopsy. Data was missing for 13%.
CHAPTER 2: PRIMARY GLOMERULONEPHRITIS
The commonest primary GN reported was Minimal Change Disease (MCD) followed by Focal
Segmental Glomerulosclerosis (FSGS) .
Minimal change disease
Accounted for 33.4% of total primary GN.
Mean age at the time of biopsy was 29.2 ± 12.9 years .
Male to female ratio was 2:1.
Nephrotic syndrome was the most common clinical presentation.
Twenty percent had e-GFR < 60 ml/min/1.73 m2 at time of biopsy
There was a higher risk of renal impairment with increasing age.
xviii
REPORT SUMMARY
con’t
Focal Segmental Glomerulosclerosis (FSGS)
Accounted for 29.3% of total primary GN.
Mean age at the time of biopsy was 33.2 ± 14.1 years .
Male to female ratio was 1.3:1.
Nephrotic syndrome was the most common clinical presentation.
Forty-nine percent had e-GFR < 60 ml/min/1.73 m2 at time of biopsy
There was a higher risk of renal impairment with increasing age
Idiopathic Membranous Nephropathy (IMN)
Accounted for 9.8% of total primary GN.
Mean age at the time of biopsy was 44.9 + 15.0 years .
Male to female ratio was 1.2:1.
Nephrotic syndrome was the most common clinical presentation.
Thirty-seven percent had e-GFR < 60 ml/min/1.73 m2 at time of biopsy .
There was a higher risk of renal impairment with increasing age
IgA nephropathy
Accounted for 19.6% of total primary GN.
Mean age at the time of biopsy was 33.1 ± 12.5 years.
Male to female ratio was 0.9:1.
Asymptomatic urine abnormalities was the most common clinical presentation, followed by
nephritic syndrome.
Forty-six percent had e-GFR < 60 ml/min/1.73 m2 at time of biopsy.
Males tend to have worse renal function at presentation compared to females.
CHAPTER 3: SECONDARY GLOMERULONEPHRITIS
The commonest secondary GN reported was lupus nephritis. Diabetic nephropathy was the second
commonest glomerular disease reported.
Lupus nephritis
Accounted for 85% of total secondary GN.
Mean age at the time of biopsy in adult lupus nephritis was 30.2 ± 10.4 years.
Male to female ratio was 7.5:1.
Urine abnormality (36%) was the commonest clinical presentation followed by nephrotic
syndrome (31%).
The commonest histopathological finding was WHO or ISN/RPS class IV or IV+V (58%).
There was no clear correlation between histopathological findings and clinical presentation.
However, class IV or class IV+V were more likely to present with symptomatic renal disease.
The prevalence of hypertension was higher in class IV or class IV +V
The prevalence of impaired kidney function correlated with histopathological findings. Class IV
was more likely to have impaired renal function.
About 2/3 of cases with lupus nephritis fulfilled 4 or more American Rheumatological Association
(ARA) criteria at presentation.
Fulfilling the ARA criteria does not predict the severity of renal lesion.
xix
REPORT SUMMARY
con’t
CHAPTER 4: PAEDIATRIC RENAL BIOPSY
This chapter reports on renal biopsy in children less than 15 years of age and the summary details the
report for the years 1999 -2009.
809 renal biopsies were performed in 755 children.
944 renal biopsies were performed in 879 children.
Majority of biopsies were performed in MOH hospitals.
900 (95.3%) were assessed to be adequate. The success rate is comparable to reports from
Thailand, UK and Japan.
729(77.7%) yielded more than 10 glomeruli.
51.5% were performed in girls.
Nephrotic syndrome (52.5%) was the most frequent clinical presentation.41.4% of the diagnosis
on biopsy was FSGS and minimal change disease in 28.4%.
The commonest biopsy finding for nephritic syndrome was post-infectious glomerulonephritis
(35.1%).
Overall, in terms of diagnosis on biopsies for the paediatric age group, lupus nephritis was the
commonest finding in 25.2%, followed closely by FSGS (24.8%) and MCD accounted for 18.1%.
There were no differences in terms of age at presentation, race, gender, urine albumin excretion
and creatinine clearance in children with FSGS and minimal change disease at biopsy.
There was no difference in patient survival for FSGS and minimal change disease.
Commonest biopsy finding for the lupus group was class IV and Class V + IV (64.6%).
Renal survival for the lupus group was 95.8% and 92.7% at 3 and 5 years.
The complication rate for renal biopsy was 5.1%. The most common complication was bleeding
which occurred in 3.6 %.
CHAPTER 5: RENAL ALLOGRAFT BIOPSY
This chapter reports on renal allograft biopsy and the summary details the report for the years 2004 2008.
The number of renal allograft biopsies doubled over the last 5 years despite a decreased in the
number of new transplant recipients.
This was largely contributed by an increase in participating centres reporting to MRRB.
The biopsies were usually performed in the age group 15 to 54 years.
Acute and chronic allograft dysfunction was the commonest indications.
In addition, there was a marked increase in the number of renal allograft biopsies performed after
one year post transplant. (49.3% in 2005 and 59.7% in 2009).
73.3% of biopsies were performed under real time ultrasound guidance. However, data was
missing in 26.3% of cases.
Complications were reported in 2.7% of the biopsies.
The histological diagnosis on biopsy in order of importance was acute rejection (36.9%),
calcineurin inhibitor toxicity (16%), chronic allograft nephropathy (14.7%) and acute tubular
necrosis (13.7%).
xx
3rd Report of the
Malaysian Registry of Renal Biopsy 2009
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
CHAPTER 1
Overview Of Renal Biopsy In Malaysia
Wa Sha’ariah Md Yusuf
Lee Ming Lee
Lee Day Guat
1
3rd Report of the
Malaysian Registry of Renal Biopsy 2009
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
1.1: Introduction
Since the establishment of the Malaysian Registry of Renal Biopsy (MRRB) on 1st January 2005 we had
successfully had two publications. The first MRRB Report 2007 was published in 2009 and the report
provided data of renal biopsy performed and reported for year 2005 to 2007 from most of the centres
providing nephrology services in the Ministry of Health (MOH). The second MRRB Report 2008 was
published in 2010 and it included data from MOH centres, universities and private hospitals. This third
MRRB Report 2009 will include renal biopsies performed in all participating centres in MOH centres,
universities and private hospitals from 2005-2009 onwards .Previous incomplete data from several
centres from the years 2005 to 2008 are included in this third report.
The MRRB has thus far come up with publications of updated data two years behind time. We hope in
future the MRRB will be able to publish the data in the next immediate year like our Malaysian Dialysis
and Transplant Registry.
1.2: Renal biopsies from the participating centres
1.2.1: Ascertainment rate of total biopsy performed
There were a total of 43 participating centres from 2005 to 2009: 23 centres (15 adult and 8 paediatric)
were from Ministry of Health (MOH), 16 were from private hospitals, 3 were from universities and 1
from Ministry of Defence. All participating centres will be identified by their individual source document
provider (SDP) number.
A total of 7085 biopsies were done since 2005 and of these 4866(68.7%) were reported. The
ascertainment rate was 62.7% for 2005, 61.0% for 2006, 73.8% for 2007, 75.7% for 2008 and 69.3% in
2009. The average ascertainment rate for 2005-2009 was 68.7%. The changes in the ascertainment rates
compared to previous reports was due to the increased number of unreported cases of biopsies
performed in the new participating centres. Some centres had voluntarily agreed to participate in the
data submission, however failed to provide the data required. There could be many factors contributing
to failure of data submission but a major factor could be due to the heavy workload among the
nephrologists.
Table 1.2.1(a): Total number of reported and unreported renal biopsies by centres, 2005-2009
Year
2005
Reported
2006
2007
2008
2009
Total
Not
Not
Not
Not
Not
Not
Reported
Reported
Reported
Reported
Reported
reported
reported
reported
reported
reported
reported
Centre
n
n
n
n
n
n
n
n
n
n
n
n
180
97
0
107
0
101
0
120
3
139
12
564
15
380
2
0
10
1
25
0
84
1
89
0
210
2
480
97
3
104
0
65
0
55
2
51
0
372
5
481
13
0
18
0
19
0
18
0
19
0
87
0
580
28
27
38
7
44
6
3
0
0
0
113
40
680
0
30
0
0
0
0
0
0
0
0
0
30
780
31
4
45
3
55
1
50
0
60
0
241
8
880
26
1
28
1
24
0
24
0
13
0
115
2
881
10
3
5
0
11
0
11
0
6
0
43
3
980
21
1
27
0
21
0
22
0
33
1
124
2
1080
68
0
81
0
61
0
94
0
88
0
392
0
2
3rd Report of the
Malaysian Registry of Renal Biopsy 2009
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
Table 1.2.1(a): Total number of reported and unreported renal biopsies by centres, 2005-2009 (cont.)
Year
2005
Reported
2006
2007
2008
2009
Total
Not
Not
Not
Not
Not
Not
Reported
Reported
Reported
Reported
Reported
reported
reported
reported
reported
reported
reported
Centre
n
n
n
n
n
n
n
n
n
n
n
n
1180
0
11
42
21
4
28
31
1
30
6
107
67
1181
0
0
2
0
7
1
0
7
0
13
9
21
1280
18
3
6
27
10
15
4
23
11
0
49
68
1380
15
0
24
0
31
1
26
11
11
5
107
17
1480
39
0
50
0
44
0
0
0
3
89
136
89
1780
74
0
101
0
63
0
87
0
75
0
400
0
2081
42
0
51
0
42
0
55
0
43
0
233
0
4380
91
4
141
0
109
12
112
14
155
1
608
31
4381
16
0
24
2
14
0
16
0
12
2
82
4
7781
28
0
24
0
37
0
41
0
26
0
156
0
20080
0
0
0
84
0
62
0
179
0
80
0
405
20180
0
193
0
239
176
0
151
28
50
128
377
588
20280
0
0
0
15
0
22
0
25
1
18
1
80
25280
4
0
2
0
4
0
2
0
2
0
14
0
60680
0
10
0
12
1
7
12
0
6
11
19
40
60980
0
0
0
9
0
12
0
12
7
3
7
36
61080
0
0
7
6
1
22
4
24
4
16
16
68
61280
1
36
0
52
0
32
4
20
10
7
15
147
61780
0
12
0
6
0
4
0
10
0
0
0
32
61880
0
20
0
20
0
20
0
0
5
7
5
67
62380
0
48
0
45
2
62
55
10
64
0
121
165
62580
0
1
0
3
0
2
2
0
3
0
5
6
65480
0
9
0
8
0
10
0
0
0
0
0
27
65780
0
0
0
0
0
8
3
0
1
1
4
9
65880
0
13
0
8
0
18
17
0
5
0
22
39
68580
0
0
0
0
0
0
19
0
16
0
35
0
106881
0
0
0
0
3
0
17
0
6
0
26
0
108180
0
0
0
29
0
0
37
7
0
69
37
105
114580
0
0
0
0
0
1
0
0
0
0
0
1
121580
0
0
0
0
0
0
0
0
0
0
0
0
126080
0
0
0
0
0
0
0
0
5
0
5
0
127780
0
0
0
0
0
0
0
0
9
0
9
0
721
429
937
598
974
346
1176
377
1058
469
4866
2219
Total
3
3rd Report of the
Malaysian Registry of Renal Biopsy 2009
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
Table 1.2.1(b): Total number of reported and unreported renal biopsies, 2005-2009
Year
2005
2006
2007
2008
2009
Total
Reported
721
937
974
1176
1058
4866
Not reported
429
598
346
377
469
2219
Total performed
1150
1535
1320
1553
1527
7085
Ascertainment rate (%)
62.7
61.04
73.79
75.72
69.29
68.68
1.2.2: Type of renal biopsy performed
As expected, majority of the biopsies reported were from native kidneys: 90.2% in 2005, 87.4% in 2006,
87.3% in 2007, 89.5% in 2008 and 87.8% in 2009. Overall, 88.4% of renal biopsies were from native
kidneys while 11.6% were from graft kidneys (Table 1.2.2).
Table 1.2.2: Distribution of reported native and graft renal biopsies by centres, 2005-2009
2005
4
2006
2007
2008
2009
Total
Native
Graft
Native
Graft
Native
Graft
Native
Graft
Native
Graft
Native
Graft
Centre
n
n
n
n
n
n
n
n
n
n
n
n
180
69
28
57
50
58
43
83
37
99
40
366
198
380
2
0
10
0
25
0
81
3
86
3
204
6
480
85
12
93
11
63
2
51
4
49
2
341
31
481
13
0
17
1
19
0
18
0
19
0
86
1
580
27
1
36
2
42
2
3
0
0
0
108
5
680
0
0
0
0
0
0
0
0
0
0
0
0
780
26
5
34
11
43
12
40
10
51
9
194
47
880
26
0
27
1
23
1
23
1
11
2
110
5
881
10
0
5
0
11
0
11
0
6
0
43
0
980
21
0
25
2
20
1
21
1
33
0
120
4
1080
68
0
79
2
61
0
93
1
87
1
388
4
1180
0
0
42
0
4
0
31
0
30
0
107
0
1181
0
0
2
0
7
0
0
0
0
0
9
0
1280
18
0
6
0
10
0
4
0
11
0
49
0
1380
15
0
24
0
31
0
26
0
10
1
106
1
1480
35
4
47
3
44
0
0
0
3
0
129
7
1780
72
2
99
2
61
2
82
5
72
3
386
14
2081
41
1
38
13
33
9
38
17
31
12
181
52
4380
73
18
122
19
87
22
97
15
112
43
491
117
4381
16
0
23
1
14
0
16
0
12
0
81
1
7781
28
0
24
0
37
0
39
2
25
1
153
3
20080
0
0
0
0
0
0
0
0
0
0
0
0
20180
0
0
0
0
146
30
124
27
43
7
313
64
3rd Report of the
Malaysian Registry of Renal Biopsy 2009
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
Table 1.2.2: Distribution of reported native and graft renal biopsies by centres, 2005-2009 (cont.)
2005
2006
2007
2008
2009
Total
Native
Graft
Native
Graft
Native
Graft
Native
Graft
Native
Graft
Native
Graft
Centre
n
n
n
n
n
n
n
n
n
n
n
n
20280
0
0
0
0
0
0
0
0
1
0
1
0
25280
4
0
2
0
4
0
2
0
2
0
14
0
60680
0
0
0
0
1
0
12
0
6
0
19
0
60980
0
0
0
0
0
0
0
0
7
0
7
0
61080
0
0
7
0
1
0
4
0
4
0
16
0
61280
1
0
0
0
0
0
4
0
10
0
15
0
61780
0
0
0
0
0
0
0
0
0
0
0
0
61880
0
0
0
0
0
0
0
0
5
0
5
0
62380
0
0
0
0
2
0
55
0
64
0
121
0
62580
0
0
0
0
0
0
2
0
3
0
5
0
65480
0
0
0
0
0
0
0
0
0
0
0
0
65780
0
0
0
0
0
0
3
0
1
0
4
0
65880
0
0
0
0
0
0
16
1
5
0
21
1
68580
0
0
0
0
0
0
19
0
16
0
35
0
106881
0
0
0
0
3
0
17
0
6
0
26
0
108180
0
0
0
0
0
0
37
0
0
0
37
0
114580
0
0
0
0
0
0
0
0
0
0
0
0
121580
0
0
0
0
0
0
0
0
0
0
0
0
126080
0
0
0
0
0
0
0
0
0
5
0
5
127780
0
0
0
0
0
0
0
0
9
0
9
0
650
71
819
118
850
124
1052
124
929
129
4300
566
Total
5
3rd Report of the
Malaysian Registry of Renal Biopsy 2009
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
1.2.3: Number of renal biopsy done on each individual patient
The data captured in MRRB is year based. New biopsies and patients biopsied before 2005 were
included. The number of biopsy episodes/attempts per patient was also recorded accordingly.
In the native biopsy group, from 2005 to 2009, a total of 4238 patients underwent renal biopsy. 3684
patients had renal biopsy for the first time, 457 patients had biopsy done twice, 84 patients had biopsy
done thrice and 13 patients had four or more biopsies. Therefore about 13.1% of patients had a repeat
native biopsy. (Table 1.2.3(a)).
In the allograft biopsy group; over the same period, 462 patients underwent a graft biopsy. 283 patients
had biopsy done once, 116 patients had biopsy done twice, 40 patients had biopsy done thrice and 23
patients had biopsy done four times or more (Table1.2.3 (b)). As expected, there was a higher rate of
repeat graft biopsies (38.7 %).
Table 1.2.3(a): Distribution of native renal biopsy in patients by number of episodes, 2005-2009
Native
2005
2006
2007
2008
2009
Total
n
%
n
%
n
%
n
%
n
%
n
st
1 episode
560
87
703
87
728
87
913
88
780
86
3684
2nd
72
11
96
12
84
10
106
10
99
11
457
3rd
10
2
9
1
25
3
15
1
25
3
84
≥4th
1
0
0
0
3
0
3
0
6
1
13
643
100
808
100
840
100
1037
100
910
100
4238
Total Patient
Table 1.2.3(b): Distribution of renal allograft biopsy in patients by number of episodes/attempts,
2005-2009
Graft
6
2005
2006
2007
2008
2009
Total
n
%
n
%
n
%
n
%
n
%
n
1st episode
48
77
70
69
60
63
54
52
51
50
283
2nd
11
18
21
21
22
23
32
31
30
30
116
3rd
3
5
7
7
9
9
10
10
11
11
40
>4th
0
0
3
3
4
4
7
7
9
9
23
Total Patient
62
100
101
100
95
100
103
100
101
100
462
3rd Report of the
Malaysian Registry of Renal Biopsy 2009
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
1.2.4: Demographic distribution of renal biopsy (Native and Graft)
1.2.4.1: Age distribution
Eighty four percent of native biopsies were done in patients older than 15 years old and in this group,
92% of the biopsies were done in patients less than 55 years age. Very few (8%) biopsies were done in
patients older than 55 years old (Table 1.2.4.1 (a)).
In the graft biopsy group, 89% were done in patients older than 15 years old and of these, 84% were in
the age group of 15 to less than 55 years. Only 11% of the graft biopsies were done in those above 55
years of age (Table 1.2.4.1(b)).
For adults (age >15years old) the highest number of renal biopsy was reported in Wilayah Persekutuan
Kuala Lumpur (34%), followed by Selangor (20%) and Penang (8%). In the paediatric group (age