4thReport renal biopsy 2010
Malaysian Society of Nephrology
Ministry of Health Malaysia
4th REPORT OF
THE MALAYSIAN REGISTRY
of
RENAL BIOPSY
2010
Sponsors:
Malaysian Society of Nephrology
The National Renal Registry is funded with grants from:
Roche
Ain Medicare
Baxter Healthcare
Fresenius Medical Care
The Ministry of Health Malaysia
i
March 2013
© 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) 4th Report of the Malaysian Registry of Renal Biopsy
2010. Kuala Lumpur 2013.
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. S. Prasad Menon
Private sector representative
Dr. Ong Loke Meng
CRC representative
Hospital Penang
Mr. Tam Chong Chiang
ADMAN representative
Hospital Tg. Ampuan
Afzan
MDTR sub-committee Chairperson
Hospital Kuala Lumpur
Dr. Lim Yam Ngo
Dr. Wong Hin Seng
eMOSS sub-committee Chairperson
Dato' Dr. Wan Shaariah Md Yusuf
University Kebangsaan
Malaysia Medical Centre
Sime Darby Medical
Centre Subang Jaya
Hospital Selayang
MRRB sub-committee Chairperson
Tuanku Ja'afar Hospital
Dr. Goh Bak Leong
MDTR Editor
Hospital Serdang
Dr. Rafidah Abdullah
Honorary MSN Treasurer
Hospital Selayang
Clinical Registry Manager
Lee Day Guat
Clinical Research Assistant
Suhazelini Ali
Choo Cheh Loo
Statistician
Adam bin Bujang
Premaa A/P Supramaniam
Tassha Hilda binti Adnan
MRRB WORKING COMMITTEE MEMBERS
Chairperson
Co-Chairperson
Dato’ Dr. Wan Sha’ariah Md Yusuf
Dr. Rosnawati Yahya
Members
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 committee established by the sponsors. The NRR Advisory Committee’s role is to ensure
that the MRRB stay focused on its objectives and to assure its continuing relevance and justification.
MRRB Steering Committee
The MRRB steering Committee supervises the operation of this registry.
National Renal Registry office
The NRR coordinating office is the designated coordinating center. It coordinates the data provided
by 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 data to the registry. The SDP collects and enters data directly
through the on-line web-based system. The pilot phase of the registry consists of SDPs from the
Ministry of Health.
Throughout this initial phase, we have refined and improved the database. In 2008, the registry
expanded to a national level and included participation from all nephrologists in Malaysia who
perform renal biopsies. It is hoped that the nephrology community will continue to support the
registry by submitting data, which is crucial to eventually improve the management of patients with
glomerular disease.
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 and paper CRF still practice. The data
variables collected include demography, clinical presentation, indications 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
List of Source Data Providers
Adult Centre Name
Sector
96 Hospital Angkatan Tentera Lumut
Armed forces
Hospital Pakar Sultanah Fatimah Muar
MOH
Kuala Lumpur Hospital
MOH
√
√
√
√
Melaka Hospital
MOH
√
√
√
√
Pulau Pinang Hospital
MOH
√
√
√
√
Queen Elizabeth Hospital
MOH
√
√
√
√
Raja Perempuan Zainab II Hospital
MOH
√
√
√
√
Raja Permaisuri Bainun Hospital
MOH
√
√
Sarawak General Hospital
MOH
√
√
√
√
Selayang Hospital
MOH
√
√
√
√
Serdang Hospital
MOH
√
√
√
Sultanah Aminah Hospital
MOH
√
√
√
√
Sultanah Bahiyah Hospital
MOH
√
√
√
√
Sultanah Nur Zahirah Hospital
MOH
√
√
√
√
Tengku Ampuan Afzan Hospital
MOH
√
√
√
√
Tengku Ampuan Rahimah Hospital
MOH
√
√
√
√
Tuanku Ja'afar Hospital
MOH
√
√
√
√
Fan Medical Renal Clinic
Private
√
√
√
Ipoh Specialist Hospital
Private
√
√
√
KPJ Ampang Puteri Specialist Hospital
Private
√
√
√
KPJ Selangor Specialist Hospital
Private
√
Lam Wah Ee Hospital
Private
√
√
√
Metro Specialist Hospital
Private
√
√
√
Normah Medical Specialist Centre
Private
√
√
√
Prince Court Medical Centre
Private
√
√
Sunway Medical Centre
Private
√
√
Teo Kidney Specialist Clinic
Private
√
√
Timberland Medical Centre
Private
√
√
Tung Shin Hospital
Private
√
√
√
University Malaya Medical Centre
University
√
√
√
Universiti Sains Malaysia Hospital
University
√
√
All
1st
Report
2nd
Report
3rd
Report
4th
Report
√
√
√
√
√
√
13
26
28
30
Paediatric Centre Name
Sector
1st Report
2nd Report
3rd Report
4th Report
Kuala Lumpur Hospital
MOH
√
√
√
√
Likas Hospital
MOH
√
√
√
√
Pulau Pinang Hospital
MOH
√
√
√
√
Selayang Hospital
MOH
√
√
√
√
Sultan Ismail Hospital
MOH
√
√
√
√
Tengku Ampuan Afzan Hospital
MOH
√
√
7
7
6
6
All
viii
CONTRIBUTING EDITORS
Chapter
1
2
Title
Authors
Institutions
Overview of Renal Biopsy in
Malaysia
Wan Sha’ariah Md Yusuf
Tuanku Ja’afar Hospital
Lee Ming Lee
Tuanku 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
Tuanku 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
5
8
9
9
12
12
13
14
17
17
17
20
20
21
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
IgA Nephropathy (IgAN)
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
2.5
Idiopathic Membranous Nephropathy
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
27
28
28
28
29
30
33
35
37
37
37
38
41
42
44
44
44
46
47
49
51
51
51
52
54
56
22
23
24
CONTENTS (con’t)
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
3.2.6.3
ARA criteria in lupus nephritis by gender
3.2.6.4
ARA criteria in lupus nephritis by histopathological findings
Extra-renal involvement
3.2.6.5
3.2.7
Survival in lupus nephritis
3.2.7.1
Patient survival in lupus nephritis
3.2.7.2
Renal survival in lupus nephritis
59
60
61
61
61
61
62
62
63
64
65
66
67
67
68
68
69
70
71
71
72
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
4.3
Outcome of renal biopsies
4.3.1
Adequacy of renal biopsy for diagnosis
4.3.2
Number of glomeruli obtained at each biopsy
4.4
Patient characteristics
4.5
Clinical presentation
4.5.1
Clinical presentation at biopsy
4.5.2
Renal function at biopsy
4.5.3
Hypertension at biopsy
4.6
Histopathological findings of paediatric renal biopsies
4.6.1 Diagnosis of paediatric renal biopsies
4.6.2 Annual frequency of main renal biopsy findings
77
78
78
78
78
78
79
79
79
79
80
80
80
80
81
81
82
72
72
72
73
73
75
75
76
xi
CONTENTS (con’t)
4.7
4.8
4.9
4.10
4.11
4.12
4.13
xii
Nephrotic syndrome
4.7.1
Renal histopathology diagnosis of children presenting with nephrotic
syndrome
4.7.2
The histopathological profile in different steroid response categories
Renal histopathology diagnosis of children presenting with nephritic syndrome
Causes of severe renal failure
Paediatric focal segmental glomerulosclerosis and minimal change disease
4.10.1 Characteristics of paediatric focal segmental glomerulosclerosis and minimal
change disease among children with steroid resistant nephrotic syndrome
4.10.2 Patient survival in focal segmental glomerulosclerosis and minimal change
disease
4.10.3 Renal survival of patient with focal segmental glomerulosclerosis and minimal
change disease
Paediatric lupus nephritis
4.11.1 Total number of patients and renal biopsies
4.11.2 Number of renal biopsy done on each individual patient with lupus
4.11.3 Patient characteristics of paediatric lupus nephritis
4.11.4 Manifestations of paediatric SLE
4.11.5 Classification of paediatric lupus nephritis
4.11.6 Patient survival in lupus nephritis
4.11.7 Renal survival of patients with lupus nephritis
Renal outcome
Biopsy failure and complication
4.13.1 Frequency of complications
4.13.2 Risk factors of complications
83
83
83
84
84
85
85
86
87
88
88
88
89
90
90
91
91
92
92
92
93
References
94
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
Biopsy Procedure
5.5.1
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
95
96
96
96
96
97
98
98
99
99
100
100
101
101
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 1.2.6 (d)
Table 1.3.1 (a)
Table 1.3.1 (b)
Table 1.3.2
Total number of biopsy performed and percentage of reported and
unreported renal biopsies by centres, 2005-2010
Total number of reported and unreported renal biopsies,2005-2010
Distribution of reported native and graft renal biopsies by centres, 20052010
Distribution of native renal biopsy in patients by number of episodes,
2005-2010
Distribution of renal allograft biopsy in patients by number of episodes,
2005-2010
Age distribution of native renal biopsy, 2005-2010
Age distribution of renal allograft biopsy, 2005-2010
Age group distribution of reported renal biopsies by state, 2005-2010
Gender distribution of native renal biopsy, 2005-2010
Gender distribution of renal allograft biopsy, 2005-2010
Racial distribution of native renal biopsy, 2005-2010
Racial distribution of renal allograft biopsy, 2005-2010
Number of glomeruli obtained at each biopsy by centres, 2005-2010
Distribution of biopsy specimens to local histopathology laboratories by
participating centres, 2005-2010
Distribution of biopsy specimens to outside histopathology laboratories
by participating centres, 2005-2010
Summary of biopsies received by local and external laboratories, 20072010
Histopathology laboratories receiving renal biopsy specimens, 20052010
Indications for native renal biopsies, 2005-2010
Renal function at time of biopsy, 2005-2010
Histopathology of all native renal biopsies, 2005-2010
3
5
6
8
8
8
9
9
10
12
12
12
12
13
14
16
16
17
17
18
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 (a)
Table 2.2.2 (b)
Table 2.2.3 (a)
Table 2.2.3 (b)
Table 2.2.3 (c)
Table 2.2.3.1 (a)
Table 2.2.3.1 (b)
Table 2.2.3.1 (c)
Table 2.2.3.2(a)
Table 2.2.3.2(b)
Table 2.2.3.2 (c)
Table 2.3.2 (a)
HPE diagnosis in patients presenting with nephrotic syndrome, 20052010
HPE diagnosis in patients presenting with urine abnormalities, 20052010
HPE diagnosis in patients presenting with nephritic-nephrotic syndrome,
2005-2010
HPE diagnosis in patients presenting with nephritic syndrome, 20052010
Primary GN according to the various age group, 2005-2010
Primary Glomerulonephritis, 2005-2010
Demographic characteristics for MCD, 2005-2010
Age group at time of biopsy (years) for MCD, 2005-2010
Clinical presentation for MCD, 2005-2010
Hypertension in MCD, 2005-2010
Renal function in MCD by year, 2005-2010
Clinical presentation by age group for MCD, 2005-2010
Hypertension by age group in MCD, 2005-2010
Renal function at presentation by age group for MCD, 2005-2010
Clinical presentation by gender for MCD, 2005-2010
Hypertension by gender for MCD, 2005-2010
Renal function by gender for MCD, 2005-2010
Demographic characteristics for FSGS, 2005-2010
20
21
22
23
24
28
29
30
31
31
32
33
33
34
35
35
36
37
xiii
LIST OF TABLES (con’t)
Table 2.3.2 (b)
Table 2.3.3 (a)
Table 2.3.3 (b)
Table 2.3.3 (c)
Table 2.3.3.1 (a)
Table 2.3.3.1 (b)
Table 2.3.3.1 (c)
Table 2.3.3.2 (a)
Table 2.3.3.2 (b)
Table 2.3.3.2 (c)
Table 2.4.2 (a)
Table 2.4.2 (b)
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 (b)
Table 2.4.3.1 (c)
Table 2.4.3.2 (a)
Table 2.4.3.2 (b)
Table 2.4.3.1 (c)
Table 2.5.2 (a)
Table 2.5.2 (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 2.5.3.2 (b)
Table 2.5.3.1 (c)
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 3.2.6.5 (a)
Table 3.2.6.5 (b)
Table 3.2.7.1
Table 3.2.7.2
Table 4.2.2
xiv
Age group at time of biopsy (years) for FSGS, 2005-2010
Clinical presentation for FSGS, 2005-2010
Presence of hypertension in FSGS, 2005-2010
Renal function in FSGS by year, 2005-2010
Clinical presentation by age group for FSGS, 2005-2010
Hypertension by age group for FSGS, 2005-2010
Renal function at presentation by age group for FSGS, 2005-2010
Clinical presentation by gender for FSGS, 2005-2010
Hypertension by gender in FSGS, 2005-2010
Renal function by gender for FSGS, 2005-2010
Demographic characteristics of patients with IgA nephropathy, 20052010
Age group at time of biopsy (years) for IgA nephropathy, 2005-2010
Clinical presentation for IgA nephropathy, 2005-2010
Hypertension in IgA nephropathy, 2005-2010
Renal function in IgA Nephropathy, 2005-2010
Clinical presentation by age group for IgA nephropathy, 2005-2010
Hypertension by age group for IgA nephropathy, 2005-2010
Renal function at presentation by age group for IgA nephropathy, 20052010
Clinical presentation by gender for IgA nephropathy, 2005-2010
Hypertension by gender for IgA nephropathy, 2005-2010
Renal function by gender for IgA nephropathy, 2005-2010
Demographic characteristics for IMN, 2005-2010
Age group at time of biopsy (years) for IMN, 2005-2010
Clinical presentation for IMN, 2005-2010
Hypertension in IMN, 2005-2010
Renal function in IMN, 2005-2010
Clinical presentation by age group for IMN, 2005-2010
Hypertension by age group for IMN, 2005-2010
Renal function at presentation by age group for IMN, 2005-2010
Clinical presentation by gender for IMN, 2005-2010
Hypertension by gender for IMN, 2005-2010
Renal function by gender for IMN, 2005-2010
Causes of secondary glomerulonephritis in adult, 2005-2010
Age group at time of biopsy (years), 2005-2010
Clinical presentation by age group, 2005-2010
Clinical presentations by histopathology in lupus nephritis, 2005-2010
Renal function by age group in lupus nephritis, 2005-2010
Renal function at presentation by histopathology, 2005-2010
Histopathological diagnosis in lupus nephritis by year, 2005-2010
Histopathological diagnosis by age group in lupus nephritis, 2005-2010
Histopathological diagnosis by gender in lupus nephritis, 2005-2010
Histopathological diagnosis by clinical presentation in lupus nephritis,
2005-2010
ARA criteria in lupus nephritis, 2005-2010
Extra-renal involvement by gender, 2005-2010
Mucocutaneous involvement by gender in lupus nephritis, 2005-2010
Patients survival estimates for death in lupus nephritis
Renal survival estimates for death in lupus nephritis
Number of patients from various hospitals
Page
38
39
39
40
41
41
42
42
43
43
44
45
46
46
47
47
47
48
49
49
50
51
52
52
53
53
54
54
55
56
56
57
60
61
64
66
67
68
69
70
71
71
72
73
74
75
76
78
LIST OF TABLES (con’t)
Table 4.2.3
Table 4.2.4
Table 4.3.1
Table 4.3.2
Table 4.4.1
Table 4.4.2
Table 4.5.1
Table 4.5.2
Table 4.5.3
Table 4.6.1
Table 4.6.2
Table 4.7.1
Number of renal biopsis
Number of renal biopsies done on each individual patient
Conclusive report
Number of glomeruli obtained at each biopsy
Gender and racial distribution
Age distribution
Clinical presentation at biopsy
Renal function at biopsy
Hypertension at biopsy
Diagnosis of paediatric renal biopsies
Annual frequency of the main renal biopsy findings 1999-2010
Renal histopathology diagnosis of children presenting with nephrotic
syndrome
Table 4.7.2
Table 4.8
The histopathological profile in different steroid response categories
Renal histopathology diagnosis of children presenting with nephritic
syndrome
Table 4.9
Histology finding of children who had severe renal failure (needed
dialysis therapy) who underwent renal biopsy
Table 4.10.1
Clinical characteristics of children with steroid resistant nephrotic
syndrome
Table 4.10.2
Patient survival for focal segmental glomerulosclerosis and minimal
change disease
Table 4.10.3
Renal survival of patient with focal segmental glomerulosclerosis and
minimal change disease
Table 4.11.1
Table 4.11.2
Table 411.3.1
Table 411.3.2
Table 411.3.3
Table 411.3.4
Table 411.3.5
Table 411.3.6
Table 4.11.4(a)
Table 4.11.4(b)
Table 4.11.5
Table 4.11.6
Table 4.11.7
Table 4.12
Total number of patient and biopsies (SLE)
Distribution of renal biopsy in patients with lupus by numbers of biopsy
Gender distribution for paediatric lupus nephritis
Racial distribution for paediatric lupus nephritis
Age for paediatric lupus nephritis
Dialysis therapy for paediatric lupus nephritis at the time of biopsy
Patient with hypertension (SLE)
Clinical presentation at biopsy (SLE)
Clinical presentation of paediatric lupus
ARA criteria at presentation
Classification of paediatric lupus nephritis
Patients survival in lupus nephritis
Renal survival of patients with lupus nephritis (ESRF & ESRF+died)
Causes of end stage renal disease in children who underwent renal
biopsy
Frequency of complications
Risk factors for complication
Number of renal allograft biopsy, 2004-2010
Number of renal allograft biopsy by centre, 2004-2010
Renal allograft biopsy by year and age group, rate (per million
population), 2004-2010
Indications for renal allograft biopsy, 2004-2010
Timing of renal allograft biopsy, 2004-2010
Biopsy method, 2004-2010
Number of passes, 2004-2010
Number of glomeruli obtained on biopsy, 2004-2010
Type of complications, 2004-2010
Histological diagnosis, 2004-2010
Table 4.13.1
Table 4.13.2
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
Page
78
78
79
79
79
79
80
80
80
81
82
83
83
84
84
85
86
87
88
88
89
89
89
89
89
89
90
90
90
91
91
92
92
93
96
96
97
98
99
99
100
100
101
101
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 (b)
Figure 2.2.3 (c)
Figure 2.2.3.1 (b)
Figure 2.2.3.1 (c)
Figure 2.2.3.2 (b)
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 (b)
Figure 2.3.3 (c)
Figure 2.3.3.1 (b)
Figure 2.3.3.1 (c)
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 (b)
Figure 2.4.3 (c)
Figure 2.4.3.2 (b)
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 (c)
Figure 2.5.3.1 (b)
Figure 2.5.3.1 (c)
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)
xvi
Primary GN according to the various age group, 2005-2010
Demographic characteristics for MCD, 2005-2010
Age at time of biopsy (years) for MCD, 2005-2010
Overall clinical presentation for MCD, 2005-2010
Presence of hypertension in MCD, 2005-2010
Impaired renal function in MCD by year, 2005-2010
Presence of hypertension by age group for MCD, 2005-2010
Impaired renal function at presentation by age group for MCD, 20052010
Presence of Hypertension by gender for MCD, 2005-2010
Impaired renal function by gender for MCD, 2005-2010
Demographic characteristics for FSGS, 2005-2010
Age at time of biopsy (years) for FSGS, 2005-2010
Overall clinical presentation for FSGS, 2005-2010
Hypertension in FSGS, 2005-2010
Impaired renal function in FSGS by year, 2005-2010
Hypertension by age group for FSGS, 2005-2010
Renal function at presentation by age group for FSGS, 2005-2010
Hypertension by gender for FSGS, 2005-2010
Impaired renal function at presentation by gender in FSGS, 2005-2010
Demographic characteristics of patients with IgA nephropathy, 20052010
Age at time of biopsy (years) for IgA nephropathy, 2005-2010
Overall clinical presentation for IgA nephropathy, 2005-2010
Hypertension in IgA nephropathy, 2005-2010
Impaired renal function in IgA nephropathy by year, 2005-2010
Hypertension by gender for IgA nephropathy, 2005-2010
Impaired renal function by gender in, 2005-2010
Demographic characteristics for IMN, 2005-2010
Age at time of biopsy (years) IMN, 2005-2010
Overall clinical presentation for IMN, 2005-2010
Renal function in IMN, 2005-2010
Hypertension by age group for IMN, 2005-2010
Renal function at presentation by age group for IMN, 2005-2010
Hypertension by gender for IMN, 2005-2010
Impaired renal function by gender, 2005-2010
Age group at time of biopsy (years), 2005-2010
Gender distribution in lupus nephritis, 2005-2010
Racial distribution in lupus nephritis, 2005-2010
Clinical presentation by year, 2005-2010
Hypertension by year in lupus nephritis, 2005-2010
Impaired renal function by year in lupus nephritis, 2005-2010
Clinical presentation by age group in lupus nephritis, 2005-2010
Hypertension by age group in lupus nephritis, 2005-2010
Impaired renal function by age group in lupus nephritis, 2005-2010
Page
25
29
30
31
32
32
34
34
35
36
37
38
39
40
40
41
42
43
44
45
45
46
48
48
49
50
51
52
53
54
55
55
56
57
61
62
62
63
63
63
64
65
65
LIST OF FIGURES (con’t)
Page
Figure 3.2.3.2 (a)
Figure 3.2.3.2 (b)
Clinical presentation by gender in lupus nephritis, 2005-2010
Hypertension by gender in lupus nephritis, 2005-2010
65
Figure 3.2.3.2 (c)
Impaired renal function by gender in lupus nephritis, 2005-2010
65
Figure 3.2.3.3 (a)
Figure 3.2.3.3 (b)
Clinical presentations by histopathology in lupus nephritis, 2005-2010
Hypertension by histopathology in lupus nephritis, 2005-2010
66
67
Figure 3.2.3.3 (c)
Impaired renal function by histopathology in lupus nephritis, 2005-2010
67
Figure 3.2.4.1
Renal function by age group in lupus nephritis, 2005-2010
67
Figure 3.2.4.2
Renal function at presentation by gender in lupus nephritis, 2005-2010
Figure 3.2.6.2
ARA criteria in lupus nephritis by age group, 2005-2010
68
72
Figure 3.2.6.3
Figure 3.2.6.4
ARA criteria in lupus nephritis by gender, 2005-2010
ARA criteria in lupus nephritis by histopathology, 2005-2010
72
Figure 3.2.6.5 (a)
Extra-renal involvement by gender in lupus nephritis, 2005-2010
74
Figure 3.2.6.5 (b)
Mucocutaneous involvement by gender in lupus nephritis, 2005-2010
74
Figure 3.2.7.1
Patients survival estimates for death in lupus nephritis
Figure 3.2.7.2
Renal survival estimates for lupus nephritis
75
76
Figure 4.10.2
Figure 4.10.3
Figure 4.11.6
Patient survival by focal segmental glomerulosclerosis and minimal
change disease
Renal survival by focal segmental glomerulosclerosis and minimal change
Patients survival estimates for lupus nephritis
Figure 4.11.7
Figure 5.2.1
Renal survival of patients with lupus nephritis
Number of renal allograft biopsy, 2004-2010
96
Figure 5.2.3
Figure 5.4
Renal allograft biopsy by year and age group, rate per million population
2004-2010
Timing of renal allograft biopsy, 2004-2010
97
98
Figure 5.5.1
Figure 5.5.2
Biopsy method (censored for missing data), 2004-2010
Number of passes, 2004-2010
100
Figure 5.5.3
Number of glomeruli obtained on biopsy, 2004-2010
100
Figure 5.5.6
Histological diagnosis, 2004-2010
101
65
73
86
88
91
91
99
xvii
4th Report of the
Malaysian Registry of Renal Biopsy 2010
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
CHAPTER 1
Overview Of Renal Biopsy In Malaysia
Wan Sha’ariah Md Yusuf
Lee Ming Lee
Lee Day Guat
1
4th Report of the
Malaysian Registry of Renal Biopsy 2010
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
1.1: Introduction
The main aim of The Malaysian Registry of Renal Biopsy (MRRB) was to collect and published data from all hospitals
performing renal biopsies. The data collected will be able to provide the pattern of glomerular disease in the
country. Unlike the first MRRB Report 2007 which only included data from the Ministry of Health (MOH), the
second MRRB Report 2008 and subsequent reports had included data from most hospitals in Malaysia performing
renal biopsies.
This fourth MRRB Report 2010 will include data of renal biopsy performed in all participating centres in MOH
centres, universities and private hospitals from 2005 to 2010. Renal biopsies performed and previously reported or
unreported from all participating centres from 2005 onwards will also be updated and reported in this fourth
MRRB report.
In 2011, the MRRB had attempted to come up with their annual publications in the next immediate year like the
Malaysian Dialysis and Transplant Registry (MDTR) but failed to do so for various reasons. One of the major reasons
was a number of participating centres had not sent in their data or if they had sent the data were incomplete. In
future, MRRB hopes to provide data, which is truly a national registry, and also to provide the clinical course of the
biopsied patients.
1.2: Renal biopsies from the participating centres
1.2.1 Ascertainment rate of total biopsy performed
From 2005 to 2010, there were a total of 45 participating centres: 23 centres (15 adult and 8 paediatric) were from
Ministry of Health (MOH), 3 were from universities, 1 from the army and 18 centres were from private hospitals.
All participating centres will be identified by their individual source document provider (SDP) number.
A total of 8624 biopsies were done since 2005 and of these 6249(72.1%) were reported. The ascertainment rate
was 62.6% for 2005, 61.1% for 2006, 74% for 2007, 76.1% for 2008, 74.2% in 2009 and 84.5% for 2010. There
appears to be a progressive improvement in the ascertainment rate. The average ascertainment rate for 20052010 was 72.1%.
2
4th Report of the
Malaysian Registry of Renal Biopsy 2010
Table 1.2.1(a): Total number of biopsy performed and percentage of reported renal biopsies by centres, 2005-2010
2005
Reported
%
100
180
Done
n
97
380
2
480
481
580
680
780
35
89
880
27
96
881
13
77
980
22
96
1080
68
100
1180
11
0
Centre
Done
n
107
2006
Reported
%
100
91
Done
n
101
25
2007
Reported
%
100
100
Done
n
123
85
2008
Reported
%
98
99
Done
n
144
89
2009
Reported
%
95
100
Done
n
171
99
2010
Reported
%
98
100
Done
n
750
311
4th Report of the
Malaysian Registry of Renal Biopsy 2010
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
Total
Reported
%
98
3
100
11
99
100
97
104
100
65
100
57
96
51
100
84
100
461
99
13
100
18
100
19
100
18
100
19
100
19
100
106
100
55
51
45
84
44
88
3
100
0
-
62
97
215
80
30
100
0
-
0
-
0
-
0
-
0
-
30
0
48
94
55
98
50
100
60
100
44
100
293
97
29
97
24
100
24
100
13
100
31
100
148
99
5
100
11
100
11
100
6
100
7
86
53
92
27
100
21
100
22
100
34
97
11
100
137
99
81
100
61
100
94
100
88
100
58
100
450
100
63
67
4
13
32
97
36
83
37
92
211
67
0
-
2
100
7
88
7
0
13
0
0
-
30
30
1280
21
81
33
18
10
40
27
15
11
100
48
19
165
35
1380
15
100
23
100
30
94
37
73
16
68
46
100
169
90
1480
39
100
50
100
44
100
0
-
92
3
85
0
310
44
1780
74
100
101
100
63
100
87
100
75
100
107
100
507
100
2081
42
100
51
100
42
100
55
100
43
100
37
100
270
100
2380
0
-
0
-
0
-
0
-
0
-
28
100
28
100
4380
95
96
141
100
121
90
126
89
156
99
141
100
780
96
4381
16
100
26
92
14
100
17
100
14
86
33
100
120
97
7781
28
100
24
100
37
100
41
100
26
100
35
100
191
100
20080
0
-
84
0
62
0
179
0
80
0
61
0
466
0
20180
193
0
239
0
176
100
179
84
178
28
0
-
965
39
20280
0
-
15
0
22
0
25
0
19
5
18
100
99
19
25280
4
100
2
100
4
100
2
100
2
100
0
-
14
100
60680
10
0
12
0
8
13
12
100
17
35
5
0
64
30
60980
0
-
9
0
12
0
12
0
10
100
8
100
51
35
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
1181
Table 1.2.1(a): Total number of biopsy performed and percentage of reported renal biopsies by centres, 2005-2010 (con’t)
2005
Reported
%
3
Done
n
23
32
2007
Reported
%
22
0
Done
n
28
24
2008
Reported
%
29
17
0
6
0
4
0
61880
20
0
20
0
20
0
62380
48
0
45
0
64
3
62580
1
0
3
0
2
0
2
65480
9
0
8
0
10
0
0
65780
0
-
0
-
8
0
3
65880
13
0
8
0
18
0
17
100
68580
0
-
0
-
0
-
19
100
106881
0
-
0
-
3
100
17
100
6
108180
0
-
29
0
0
-
44
84
69
112780
0
-
0
-
0
-
0
-
0
114580
0
-
0
-
1
0
0
-
0
-
0
-
1
0
121580
0
-
0
-
0
-
0
-
0
-
5
0
5
0
126080
0
-
0
-
0
-
0
-
5
100
57
100
62
100
127780
0
-
0
-
0
-
0
-
9
100
9
100
18
100
1150
63
1534
61
1320
74
1554
76
1528
74
1538
84
8624
72
0
-
Done
n
94
185
Total
Reported
%
40
11
12
-
Done
n
10
23
2010
Reported
%
100
26
61780
10
Done
n
20
17
2009
Reported
%
35
59
61080
61280
4
Total
Done
n
13
52
2006
Reported
%
62
0
Done
n
0
37
Centre
32
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
4th Report of the
Malaysian Registry of Renal Biopsy 2010
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
0
0
0
0
-
12
42
0
-
72
7
65
85
65
100
54
98
341
51
100
3
100
0
-
11
45
-
0
-
0
-
27
0
100
2
50
0
-
13
31
5
100
12
100
73
47
16
100
17
53
52
85
100
7
100
33
100
93
68
90
210
77
-
1
0
1
0
4th Report of the
Malaysian Registry of Renal Biopsy 2010
4th Report of the
Malaysian Registry of Renal Biopsy 2010
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
Table 1.2.1(b): Total number of reported and unreported renal biopsies, 2005-2010
Year
2005
2006
2007
2008
2009
2010
Total
Reported
720
937
977
1182
1134
1299
6249
Not reported
430
597
343
372
394
239
2375
Total performed
1150
1534
1320
1554
1528
1538
8624
Ascertainment rate (%)
62.6
61.1
74.0
76.1
74.2
84.5
72.1
1.2.2 Type of renal biopsy performed
As expected, majority of the biopsies reported were from native kidneys; 90.1% in 2005, 87.4% in 2006, 87.3% in
2007, 89.5% in 2008, 88.3% in 2009 and 86.1% in 2010. Overall, 88% of renal biopsies were from native kidneys
while 12% were from graft kidneys (Table 1.2.2).
5
Table 1.2.2: Distribution of reported native and graft renal biopsies by centre, 2005-2010
2005
Centre
180
2006
2007
2008
2009
2010
Total
Native
n
Graft
n
Native
n
Graft
n
Native
n
Graft
n
Native
n
Graft
n
Native
n
Graft
n
Native
n
Graft
n
Native
n
Graft
n
69
28
57
50
58
43
83
37
103
41
125
42
495
241
6
2
0
10
0
25
0
81
3
86
3
90
9
294
15
480
85
12
93
11
63
2
51
4
49
2
71
13
412
44
481
13
0
17
1
19
0
18
0
19
0
19
0
105
1
580
27
1
36
2
42
2
3
0
0
0
60
0
168
5
780
26
5
34
11
43
12
40
10
51
9
41
3
235
50
880
26
0
27
1
23
1
23
1
11
2
31
0
141
5
881
10
0
5
0
11
0
11
0
6
0
6
0
49
0
980
21
0
25
2
20
1
21
1
33
0
11
0
131
4
1080
68
0
79
2
61
0
93
1
87
1
56
2
444
6
1180
0
0
42
0
4
0
31
0
30
0
34
0
141
0
1181
0
0
2
0
7
0
0
0
0
0
0
0
9
0
1280
17
0
6
0
10
0
4
0
11
0
9
0
57
0
1380
15
0
23
0
30
0
27
0
10
1
46
0
151
1
1480
35
4
47
3
44
0
0
0
3
0
0
0
129
7
1780
72
2
99
2
61
2
82
5
72
3
99
8
485
22
2081
41
1
38
13
33
9
38
17
31
12
27
10
208
62
2380
0
0
0
0
0
0
0
0
0
0
27
1
27
1
4380
73
18
122
19
87
22
97
15
112
43
104
37
595
154
4381
16
0
23
1
14
0
17
0
12
0
32
1
114
2
7781
28
0
24
0
37
0
39
2
25
1
31
4
184
7
20180
0
0
0
0
146
30
124
27
43
7
0
0
313
64
20280
0
0
0
0
0
0
0
0
1
0
18
0
19
0
25280
4
0
2
0
4
0
2
0
2
0
0
0
14
0
60680
0
0
0
0
1
0
12
0
6
0
0
0
19
0
60980
0
0
0
0
0
0
0
0
10
0
8
0
18
0
61080
0
0
8
0
5
0
8
0
7
0
10
0
38
0
61280
1
0
0
0
0
0
4
0
10
0
5
1
20
1
4th Report of the
Malaysian Registry of Renal Biopsy 2010
380
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
4th Report of the
Malaysian Registry of Renal Biopsy 2010
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
4th Report of the
Malaysian Registry of Renal Biopsy 2010
Table 1.2.2: Distribution of reported native and graft renal biopsies by centre, 2005-2010 (con’t)
2005
Centre
2006
2007
2008
2009
2010
Total
Native
Graft
Native
Graft
Native
Graft
Native
Graft
Native
Graft
Native
Graft
Native
Graft
7
n
n
n
n
n
n
n
n
n
n
n
n
n
n
61880
0
0
0
0
0
0
0
0
5
0
0
0
5
0
62380
0
0
0
0
2
0
55
0
65
0
53
0
175
0
62580
0
0
0
0
0
0
2
0
3
0
0
0
5
0
65780
0
0
0
0
0
0
3
0
1
0
0
0
4
0
65880
0
0
0
0
0
0
16
1
5
0
11
1
32
2
68580
0
0
0
0
0
0
19
0
16
0
9
0
44
0
106881
0
0
0
0
3
0
17
0
6
0
7
0
33
0
108180
0
0
0
0
0
0
37
0
61
3
60
1
158
4
126080
0
0
0
0
0
0
0
0
0
5
10
47
10
52
127780
0
0
0
0
0
0
0
0
9
0
9
0
18
0
649
71
819
118
853
124
1058
124
1001
133
1119
180
5499
750
Total
4th Report of the
Malaysian Registry of Renal Biopsy 2010
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
4th Report of the
Malaysian Registry of Renal Biopsy 2010
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.
From 2005 to 2010, a total of 5415 patients underwent native renal biopsy. 4701 (86.8%) patients had renal
biopsy for the first time, 574 (10.6%) patients had biopsy done twice, 120 (2.2%) patients had biopsy done thrice
and 20 (0.4%) patients had four or more biopsies. Therefore about 13.2% of patients had a repeat native biopsy
done (Table 1.2.3(a)).
Over the same period, 585 patients underwent renal allograft biopsy. 342(58.5%) patients had biopsy done once,
148(25.3%) patients had biopsy done twice, 55(9.4%) patients had biopsy done thrice and 40 patients had biopsy
done four times or more (Table1.2.3 (b)). As expected, there was a higher rate of repeat graft biopsies (41.5 %)
compared to native kidneys (13.2%).
Table 1.2.3(a): Distribution of native renal biopsy in patients by number of episodes, 2005-2010
Native
st
1 episode
2005
2006
2007
2008
2009
2010
Total
n
%
n
%
n
%
n
%
n
%
n
%
n
%
559
87.1
704
87.1
731
86.7
919
88.1
847
86.3
941
85.8
4701
86.8
nd
episode
72
11.2
95
11.8
84
10.0
106
10.2
103
10.5
114
10.4
574
10.6
rd
episode
10
1.6
9
1.1
25
3.0
15
1.4
26
2.7
35
3.2
120
2.2
≥4 episode
1
0.2
0
0.0
3
0.4
3
0.3
6
0.6
7
0.6
20
0.4
Total Patient
642
100
808
100
843
100
1043
100
982
100
1097
100
5415
100
2
3
th
Table 1.2.3 (b): Distribution of renal allograft biopsy in patients by number of episodes/attempts, 2005-2010
2005
Graft
2006
2007
2008
2009
2010
Total
n
%
n
%
n
%
n
%
n
%
n
%
n
%
1st episode
48
77.4
70
69.3
60
63.2
54
52.4
52
50.0
58
48.0
342
58.5
2nd episode
11
17.7
21
20.8
22
23.2
32
31.1
32
30.8
30
25.0
148
25.3
3 episode
3
4.8
7
6.9
9
9.5
10
9.7
11
10.6
15
12.5
55
9.4
≥4th episode
0
0.0
3
3.0
4
4.2
7
6.8
9
8.7
17
14.2
40
6.8
Total Patient
62
100
101
100
95
100
103
100
104
100
120
100
585
100
rd
8
4th Report of the
Malaysian Registry of Renal Biopsy 2010
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
1.2.4: Demographic distribution of renal biopsy (Native and Graft)
1.2.4.1: Age distribution
About 84.2% 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 age. Very few (7.4%) biopsies were done in patients older than 55
years old. (Table 1.2.4.1 (a))
In the graft biopsy group, 95.1% were done in patients older than 15 years old and of these, 89.1% were in the age
group of 15 to less than 55 years. Only 10.4% 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 Selangor (23.2%); followed by
Wilayah Persekutuan Kuala Lumpur (22.9%) and Penang (11.7%). In the paediatric group (age < 15 years old), the
highest number of renal biopsy were reported in WP Kuala Lumpur (27.2%); followed by Johor (21.6%) and Selangor
(16.4%). (Table1.2.4.1 (c))
Table 1.2.4.1(a): Age distribution of native renal biopsy, 2005-2010
Age group
(years)
2005
n
2006
n
2007
n
2008
n
2009
n
2010
n
Ministry of Health Malaysia
4th REPORT OF
THE MALAYSIAN REGISTRY
of
RENAL BIOPSY
2010
Sponsors:
Malaysian Society of Nephrology
The National Renal Registry is funded with grants from:
Roche
Ain Medicare
Baxter Healthcare
Fresenius Medical Care
The Ministry of Health Malaysia
i
March 2013
© 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) 4th Report of the Malaysian Registry of Renal Biopsy
2010. Kuala Lumpur 2013.
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. S. Prasad Menon
Private sector representative
Dr. Ong Loke Meng
CRC representative
Hospital Penang
Mr. Tam Chong Chiang
ADMAN representative
Hospital Tg. Ampuan
Afzan
MDTR sub-committee Chairperson
Hospital Kuala Lumpur
Dr. Lim Yam Ngo
Dr. Wong Hin Seng
eMOSS sub-committee Chairperson
Dato' Dr. Wan Shaariah Md Yusuf
University Kebangsaan
Malaysia Medical Centre
Sime Darby Medical
Centre Subang Jaya
Hospital Selayang
MRRB sub-committee Chairperson
Tuanku Ja'afar Hospital
Dr. Goh Bak Leong
MDTR Editor
Hospital Serdang
Dr. Rafidah Abdullah
Honorary MSN Treasurer
Hospital Selayang
Clinical Registry Manager
Lee Day Guat
Clinical Research Assistant
Suhazelini Ali
Choo Cheh Loo
Statistician
Adam bin Bujang
Premaa A/P Supramaniam
Tassha Hilda binti Adnan
MRRB WORKING COMMITTEE MEMBERS
Chairperson
Co-Chairperson
Dato’ Dr. Wan Sha’ariah Md Yusuf
Dr. Rosnawati Yahya
Members
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 committee established by the sponsors. The NRR Advisory Committee’s role is to ensure
that the MRRB stay focused on its objectives and to assure its continuing relevance and justification.
MRRB Steering Committee
The MRRB steering Committee supervises the operation of this registry.
National Renal Registry office
The NRR coordinating office is the designated coordinating center. It coordinates the data provided
by 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 data to the registry. The SDP collects and enters data directly
through the on-line web-based system. The pilot phase of the registry consists of SDPs from the
Ministry of Health.
Throughout this initial phase, we have refined and improved the database. In 2008, the registry
expanded to a national level and included participation from all nephrologists in Malaysia who
perform renal biopsies. It is hoped that the nephrology community will continue to support the
registry by submitting data, which is crucial to eventually improve the management of patients with
glomerular disease.
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 and paper CRF still practice. The data
variables collected include demography, clinical presentation, indications 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
List of Source Data Providers
Adult Centre Name
Sector
96 Hospital Angkatan Tentera Lumut
Armed forces
Hospital Pakar Sultanah Fatimah Muar
MOH
Kuala Lumpur Hospital
MOH
√
√
√
√
Melaka Hospital
MOH
√
√
√
√
Pulau Pinang Hospital
MOH
√
√
√
√
Queen Elizabeth Hospital
MOH
√
√
√
√
Raja Perempuan Zainab II Hospital
MOH
√
√
√
√
Raja Permaisuri Bainun Hospital
MOH
√
√
Sarawak General Hospital
MOH
√
√
√
√
Selayang Hospital
MOH
√
√
√
√
Serdang Hospital
MOH
√
√
√
Sultanah Aminah Hospital
MOH
√
√
√
√
Sultanah Bahiyah Hospital
MOH
√
√
√
√
Sultanah Nur Zahirah Hospital
MOH
√
√
√
√
Tengku Ampuan Afzan Hospital
MOH
√
√
√
√
Tengku Ampuan Rahimah Hospital
MOH
√
√
√
√
Tuanku Ja'afar Hospital
MOH
√
√
√
√
Fan Medical Renal Clinic
Private
√
√
√
Ipoh Specialist Hospital
Private
√
√
√
KPJ Ampang Puteri Specialist Hospital
Private
√
√
√
KPJ Selangor Specialist Hospital
Private
√
Lam Wah Ee Hospital
Private
√
√
√
Metro Specialist Hospital
Private
√
√
√
Normah Medical Specialist Centre
Private
√
√
√
Prince Court Medical Centre
Private
√
√
Sunway Medical Centre
Private
√
√
Teo Kidney Specialist Clinic
Private
√
√
Timberland Medical Centre
Private
√
√
Tung Shin Hospital
Private
√
√
√
University Malaya Medical Centre
University
√
√
√
Universiti Sains Malaysia Hospital
University
√
√
All
1st
Report
2nd
Report
3rd
Report
4th
Report
√
√
√
√
√
√
13
26
28
30
Paediatric Centre Name
Sector
1st Report
2nd Report
3rd Report
4th Report
Kuala Lumpur Hospital
MOH
√
√
√
√
Likas Hospital
MOH
√
√
√
√
Pulau Pinang Hospital
MOH
√
√
√
√
Selayang Hospital
MOH
√
√
√
√
Sultan Ismail Hospital
MOH
√
√
√
√
Tengku Ampuan Afzan Hospital
MOH
√
√
7
7
6
6
All
viii
CONTRIBUTING EDITORS
Chapter
1
2
Title
Authors
Institutions
Overview of Renal Biopsy in
Malaysia
Wan Sha’ariah Md Yusuf
Tuanku Ja’afar Hospital
Lee Ming Lee
Tuanku 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
Tuanku 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
5
8
9
9
12
12
13
14
17
17
17
20
20
21
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
IgA Nephropathy (IgAN)
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
2.5
Idiopathic Membranous Nephropathy
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
27
28
28
28
29
30
33
35
37
37
37
38
41
42
44
44
44
46
47
49
51
51
51
52
54
56
22
23
24
CONTENTS (con’t)
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
3.2.6.3
ARA criteria in lupus nephritis by gender
3.2.6.4
ARA criteria in lupus nephritis by histopathological findings
Extra-renal involvement
3.2.6.5
3.2.7
Survival in lupus nephritis
3.2.7.1
Patient survival in lupus nephritis
3.2.7.2
Renal survival in lupus nephritis
59
60
61
61
61
61
62
62
63
64
65
66
67
67
68
68
69
70
71
71
72
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
4.3
Outcome of renal biopsies
4.3.1
Adequacy of renal biopsy for diagnosis
4.3.2
Number of glomeruli obtained at each biopsy
4.4
Patient characteristics
4.5
Clinical presentation
4.5.1
Clinical presentation at biopsy
4.5.2
Renal function at biopsy
4.5.3
Hypertension at biopsy
4.6
Histopathological findings of paediatric renal biopsies
4.6.1 Diagnosis of paediatric renal biopsies
4.6.2 Annual frequency of main renal biopsy findings
77
78
78
78
78
78
79
79
79
79
80
80
80
80
81
81
82
72
72
72
73
73
75
75
76
xi
CONTENTS (con’t)
4.7
4.8
4.9
4.10
4.11
4.12
4.13
xii
Nephrotic syndrome
4.7.1
Renal histopathology diagnosis of children presenting with nephrotic
syndrome
4.7.2
The histopathological profile in different steroid response categories
Renal histopathology diagnosis of children presenting with nephritic syndrome
Causes of severe renal failure
Paediatric focal segmental glomerulosclerosis and minimal change disease
4.10.1 Characteristics of paediatric focal segmental glomerulosclerosis and minimal
change disease among children with steroid resistant nephrotic syndrome
4.10.2 Patient survival in focal segmental glomerulosclerosis and minimal change
disease
4.10.3 Renal survival of patient with focal segmental glomerulosclerosis and minimal
change disease
Paediatric lupus nephritis
4.11.1 Total number of patients and renal biopsies
4.11.2 Number of renal biopsy done on each individual patient with lupus
4.11.3 Patient characteristics of paediatric lupus nephritis
4.11.4 Manifestations of paediatric SLE
4.11.5 Classification of paediatric lupus nephritis
4.11.6 Patient survival in lupus nephritis
4.11.7 Renal survival of patients with lupus nephritis
Renal outcome
Biopsy failure and complication
4.13.1 Frequency of complications
4.13.2 Risk factors of complications
83
83
83
84
84
85
85
86
87
88
88
88
89
90
90
91
91
92
92
92
93
References
94
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
Biopsy Procedure
5.5.1
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
95
96
96
96
96
97
98
98
99
99
100
100
101
101
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 1.2.6 (d)
Table 1.3.1 (a)
Table 1.3.1 (b)
Table 1.3.2
Total number of biopsy performed and percentage of reported and
unreported renal biopsies by centres, 2005-2010
Total number of reported and unreported renal biopsies,2005-2010
Distribution of reported native and graft renal biopsies by centres, 20052010
Distribution of native renal biopsy in patients by number of episodes,
2005-2010
Distribution of renal allograft biopsy in patients by number of episodes,
2005-2010
Age distribution of native renal biopsy, 2005-2010
Age distribution of renal allograft biopsy, 2005-2010
Age group distribution of reported renal biopsies by state, 2005-2010
Gender distribution of native renal biopsy, 2005-2010
Gender distribution of renal allograft biopsy, 2005-2010
Racial distribution of native renal biopsy, 2005-2010
Racial distribution of renal allograft biopsy, 2005-2010
Number of glomeruli obtained at each biopsy by centres, 2005-2010
Distribution of biopsy specimens to local histopathology laboratories by
participating centres, 2005-2010
Distribution of biopsy specimens to outside histopathology laboratories
by participating centres, 2005-2010
Summary of biopsies received by local and external laboratories, 20072010
Histopathology laboratories receiving renal biopsy specimens, 20052010
Indications for native renal biopsies, 2005-2010
Renal function at time of biopsy, 2005-2010
Histopathology of all native renal biopsies, 2005-2010
3
5
6
8
8
8
9
9
10
12
12
12
12
13
14
16
16
17
17
18
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 (a)
Table 2.2.2 (b)
Table 2.2.3 (a)
Table 2.2.3 (b)
Table 2.2.3 (c)
Table 2.2.3.1 (a)
Table 2.2.3.1 (b)
Table 2.2.3.1 (c)
Table 2.2.3.2(a)
Table 2.2.3.2(b)
Table 2.2.3.2 (c)
Table 2.3.2 (a)
HPE diagnosis in patients presenting with nephrotic syndrome, 20052010
HPE diagnosis in patients presenting with urine abnormalities, 20052010
HPE diagnosis in patients presenting with nephritic-nephrotic syndrome,
2005-2010
HPE diagnosis in patients presenting with nephritic syndrome, 20052010
Primary GN according to the various age group, 2005-2010
Primary Glomerulonephritis, 2005-2010
Demographic characteristics for MCD, 2005-2010
Age group at time of biopsy (years) for MCD, 2005-2010
Clinical presentation for MCD, 2005-2010
Hypertension in MCD, 2005-2010
Renal function in MCD by year, 2005-2010
Clinical presentation by age group for MCD, 2005-2010
Hypertension by age group in MCD, 2005-2010
Renal function at presentation by age group for MCD, 2005-2010
Clinical presentation by gender for MCD, 2005-2010
Hypertension by gender for MCD, 2005-2010
Renal function by gender for MCD, 2005-2010
Demographic characteristics for FSGS, 2005-2010
20
21
22
23
24
28
29
30
31
31
32
33
33
34
35
35
36
37
xiii
LIST OF TABLES (con’t)
Table 2.3.2 (b)
Table 2.3.3 (a)
Table 2.3.3 (b)
Table 2.3.3 (c)
Table 2.3.3.1 (a)
Table 2.3.3.1 (b)
Table 2.3.3.1 (c)
Table 2.3.3.2 (a)
Table 2.3.3.2 (b)
Table 2.3.3.2 (c)
Table 2.4.2 (a)
Table 2.4.2 (b)
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 (b)
Table 2.4.3.1 (c)
Table 2.4.3.2 (a)
Table 2.4.3.2 (b)
Table 2.4.3.1 (c)
Table 2.5.2 (a)
Table 2.5.2 (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 2.5.3.2 (b)
Table 2.5.3.1 (c)
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 3.2.6.5 (a)
Table 3.2.6.5 (b)
Table 3.2.7.1
Table 3.2.7.2
Table 4.2.2
xiv
Age group at time of biopsy (years) for FSGS, 2005-2010
Clinical presentation for FSGS, 2005-2010
Presence of hypertension in FSGS, 2005-2010
Renal function in FSGS by year, 2005-2010
Clinical presentation by age group for FSGS, 2005-2010
Hypertension by age group for FSGS, 2005-2010
Renal function at presentation by age group for FSGS, 2005-2010
Clinical presentation by gender for FSGS, 2005-2010
Hypertension by gender in FSGS, 2005-2010
Renal function by gender for FSGS, 2005-2010
Demographic characteristics of patients with IgA nephropathy, 20052010
Age group at time of biopsy (years) for IgA nephropathy, 2005-2010
Clinical presentation for IgA nephropathy, 2005-2010
Hypertension in IgA nephropathy, 2005-2010
Renal function in IgA Nephropathy, 2005-2010
Clinical presentation by age group for IgA nephropathy, 2005-2010
Hypertension by age group for IgA nephropathy, 2005-2010
Renal function at presentation by age group for IgA nephropathy, 20052010
Clinical presentation by gender for IgA nephropathy, 2005-2010
Hypertension by gender for IgA nephropathy, 2005-2010
Renal function by gender for IgA nephropathy, 2005-2010
Demographic characteristics for IMN, 2005-2010
Age group at time of biopsy (years) for IMN, 2005-2010
Clinical presentation for IMN, 2005-2010
Hypertension in IMN, 2005-2010
Renal function in IMN, 2005-2010
Clinical presentation by age group for IMN, 2005-2010
Hypertension by age group for IMN, 2005-2010
Renal function at presentation by age group for IMN, 2005-2010
Clinical presentation by gender for IMN, 2005-2010
Hypertension by gender for IMN, 2005-2010
Renal function by gender for IMN, 2005-2010
Causes of secondary glomerulonephritis in adult, 2005-2010
Age group at time of biopsy (years), 2005-2010
Clinical presentation by age group, 2005-2010
Clinical presentations by histopathology in lupus nephritis, 2005-2010
Renal function by age group in lupus nephritis, 2005-2010
Renal function at presentation by histopathology, 2005-2010
Histopathological diagnosis in lupus nephritis by year, 2005-2010
Histopathological diagnosis by age group in lupus nephritis, 2005-2010
Histopathological diagnosis by gender in lupus nephritis, 2005-2010
Histopathological diagnosis by clinical presentation in lupus nephritis,
2005-2010
ARA criteria in lupus nephritis, 2005-2010
Extra-renal involvement by gender, 2005-2010
Mucocutaneous involvement by gender in lupus nephritis, 2005-2010
Patients survival estimates for death in lupus nephritis
Renal survival estimates for death in lupus nephritis
Number of patients from various hospitals
Page
38
39
39
40
41
41
42
42
43
43
44
45
46
46
47
47
47
48
49
49
50
51
52
52
53
53
54
54
55
56
56
57
60
61
64
66
67
68
69
70
71
71
72
73
74
75
76
78
LIST OF TABLES (con’t)
Table 4.2.3
Table 4.2.4
Table 4.3.1
Table 4.3.2
Table 4.4.1
Table 4.4.2
Table 4.5.1
Table 4.5.2
Table 4.5.3
Table 4.6.1
Table 4.6.2
Table 4.7.1
Number of renal biopsis
Number of renal biopsies done on each individual patient
Conclusive report
Number of glomeruli obtained at each biopsy
Gender and racial distribution
Age distribution
Clinical presentation at biopsy
Renal function at biopsy
Hypertension at biopsy
Diagnosis of paediatric renal biopsies
Annual frequency of the main renal biopsy findings 1999-2010
Renal histopathology diagnosis of children presenting with nephrotic
syndrome
Table 4.7.2
Table 4.8
The histopathological profile in different steroid response categories
Renal histopathology diagnosis of children presenting with nephritic
syndrome
Table 4.9
Histology finding of children who had severe renal failure (needed
dialysis therapy) who underwent renal biopsy
Table 4.10.1
Clinical characteristics of children with steroid resistant nephrotic
syndrome
Table 4.10.2
Patient survival for focal segmental glomerulosclerosis and minimal
change disease
Table 4.10.3
Renal survival of patient with focal segmental glomerulosclerosis and
minimal change disease
Table 4.11.1
Table 4.11.2
Table 411.3.1
Table 411.3.2
Table 411.3.3
Table 411.3.4
Table 411.3.5
Table 411.3.6
Table 4.11.4(a)
Table 4.11.4(b)
Table 4.11.5
Table 4.11.6
Table 4.11.7
Table 4.12
Total number of patient and biopsies (SLE)
Distribution of renal biopsy in patients with lupus by numbers of biopsy
Gender distribution for paediatric lupus nephritis
Racial distribution for paediatric lupus nephritis
Age for paediatric lupus nephritis
Dialysis therapy for paediatric lupus nephritis at the time of biopsy
Patient with hypertension (SLE)
Clinical presentation at biopsy (SLE)
Clinical presentation of paediatric lupus
ARA criteria at presentation
Classification of paediatric lupus nephritis
Patients survival in lupus nephritis
Renal survival of patients with lupus nephritis (ESRF & ESRF+died)
Causes of end stage renal disease in children who underwent renal
biopsy
Frequency of complications
Risk factors for complication
Number of renal allograft biopsy, 2004-2010
Number of renal allograft biopsy by centre, 2004-2010
Renal allograft biopsy by year and age group, rate (per million
population), 2004-2010
Indications for renal allograft biopsy, 2004-2010
Timing of renal allograft biopsy, 2004-2010
Biopsy method, 2004-2010
Number of passes, 2004-2010
Number of glomeruli obtained on biopsy, 2004-2010
Type of complications, 2004-2010
Histological diagnosis, 2004-2010
Table 4.13.1
Table 4.13.2
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
Page
78
78
79
79
79
79
80
80
80
81
82
83
83
84
84
85
86
87
88
88
89
89
89
89
89
89
90
90
90
91
91
92
92
93
96
96
97
98
99
99
100
100
101
101
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 (b)
Figure 2.2.3 (c)
Figure 2.2.3.1 (b)
Figure 2.2.3.1 (c)
Figure 2.2.3.2 (b)
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 (b)
Figure 2.3.3 (c)
Figure 2.3.3.1 (b)
Figure 2.3.3.1 (c)
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 (b)
Figure 2.4.3 (c)
Figure 2.4.3.2 (b)
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 (c)
Figure 2.5.3.1 (b)
Figure 2.5.3.1 (c)
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)
xvi
Primary GN according to the various age group, 2005-2010
Demographic characteristics for MCD, 2005-2010
Age at time of biopsy (years) for MCD, 2005-2010
Overall clinical presentation for MCD, 2005-2010
Presence of hypertension in MCD, 2005-2010
Impaired renal function in MCD by year, 2005-2010
Presence of hypertension by age group for MCD, 2005-2010
Impaired renal function at presentation by age group for MCD, 20052010
Presence of Hypertension by gender for MCD, 2005-2010
Impaired renal function by gender for MCD, 2005-2010
Demographic characteristics for FSGS, 2005-2010
Age at time of biopsy (years) for FSGS, 2005-2010
Overall clinical presentation for FSGS, 2005-2010
Hypertension in FSGS, 2005-2010
Impaired renal function in FSGS by year, 2005-2010
Hypertension by age group for FSGS, 2005-2010
Renal function at presentation by age group for FSGS, 2005-2010
Hypertension by gender for FSGS, 2005-2010
Impaired renal function at presentation by gender in FSGS, 2005-2010
Demographic characteristics of patients with IgA nephropathy, 20052010
Age at time of biopsy (years) for IgA nephropathy, 2005-2010
Overall clinical presentation for IgA nephropathy, 2005-2010
Hypertension in IgA nephropathy, 2005-2010
Impaired renal function in IgA nephropathy by year, 2005-2010
Hypertension by gender for IgA nephropathy, 2005-2010
Impaired renal function by gender in, 2005-2010
Demographic characteristics for IMN, 2005-2010
Age at time of biopsy (years) IMN, 2005-2010
Overall clinical presentation for IMN, 2005-2010
Renal function in IMN, 2005-2010
Hypertension by age group for IMN, 2005-2010
Renal function at presentation by age group for IMN, 2005-2010
Hypertension by gender for IMN, 2005-2010
Impaired renal function by gender, 2005-2010
Age group at time of biopsy (years), 2005-2010
Gender distribution in lupus nephritis, 2005-2010
Racial distribution in lupus nephritis, 2005-2010
Clinical presentation by year, 2005-2010
Hypertension by year in lupus nephritis, 2005-2010
Impaired renal function by year in lupus nephritis, 2005-2010
Clinical presentation by age group in lupus nephritis, 2005-2010
Hypertension by age group in lupus nephritis, 2005-2010
Impaired renal function by age group in lupus nephritis, 2005-2010
Page
25
29
30
31
32
32
34
34
35
36
37
38
39
40
40
41
42
43
44
45
45
46
48
48
49
50
51
52
53
54
55
55
56
57
61
62
62
63
63
63
64
65
65
LIST OF FIGURES (con’t)
Page
Figure 3.2.3.2 (a)
Figure 3.2.3.2 (b)
Clinical presentation by gender in lupus nephritis, 2005-2010
Hypertension by gender in lupus nephritis, 2005-2010
65
Figure 3.2.3.2 (c)
Impaired renal function by gender in lupus nephritis, 2005-2010
65
Figure 3.2.3.3 (a)
Figure 3.2.3.3 (b)
Clinical presentations by histopathology in lupus nephritis, 2005-2010
Hypertension by histopathology in lupus nephritis, 2005-2010
66
67
Figure 3.2.3.3 (c)
Impaired renal function by histopathology in lupus nephritis, 2005-2010
67
Figure 3.2.4.1
Renal function by age group in lupus nephritis, 2005-2010
67
Figure 3.2.4.2
Renal function at presentation by gender in lupus nephritis, 2005-2010
Figure 3.2.6.2
ARA criteria in lupus nephritis by age group, 2005-2010
68
72
Figure 3.2.6.3
Figure 3.2.6.4
ARA criteria in lupus nephritis by gender, 2005-2010
ARA criteria in lupus nephritis by histopathology, 2005-2010
72
Figure 3.2.6.5 (a)
Extra-renal involvement by gender in lupus nephritis, 2005-2010
74
Figure 3.2.6.5 (b)
Mucocutaneous involvement by gender in lupus nephritis, 2005-2010
74
Figure 3.2.7.1
Patients survival estimates for death in lupus nephritis
Figure 3.2.7.2
Renal survival estimates for lupus nephritis
75
76
Figure 4.10.2
Figure 4.10.3
Figure 4.11.6
Patient survival by focal segmental glomerulosclerosis and minimal
change disease
Renal survival by focal segmental glomerulosclerosis and minimal change
Patients survival estimates for lupus nephritis
Figure 4.11.7
Figure 5.2.1
Renal survival of patients with lupus nephritis
Number of renal allograft biopsy, 2004-2010
96
Figure 5.2.3
Figure 5.4
Renal allograft biopsy by year and age group, rate per million population
2004-2010
Timing of renal allograft biopsy, 2004-2010
97
98
Figure 5.5.1
Figure 5.5.2
Biopsy method (censored for missing data), 2004-2010
Number of passes, 2004-2010
100
Figure 5.5.3
Number of glomeruli obtained on biopsy, 2004-2010
100
Figure 5.5.6
Histological diagnosis, 2004-2010
101
65
73
86
88
91
91
99
xvii
4th Report of the
Malaysian Registry of Renal Biopsy 2010
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
CHAPTER 1
Overview Of Renal Biopsy In Malaysia
Wan Sha’ariah Md Yusuf
Lee Ming Lee
Lee Day Guat
1
4th Report of the
Malaysian Registry of Renal Biopsy 2010
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
1.1: Introduction
The main aim of The Malaysian Registry of Renal Biopsy (MRRB) was to collect and published data from all hospitals
performing renal biopsies. The data collected will be able to provide the pattern of glomerular disease in the
country. Unlike the first MRRB Report 2007 which only included data from the Ministry of Health (MOH), the
second MRRB Report 2008 and subsequent reports had included data from most hospitals in Malaysia performing
renal biopsies.
This fourth MRRB Report 2010 will include data of renal biopsy performed in all participating centres in MOH
centres, universities and private hospitals from 2005 to 2010. Renal biopsies performed and previously reported or
unreported from all participating centres from 2005 onwards will also be updated and reported in this fourth
MRRB report.
In 2011, the MRRB had attempted to come up with their annual publications in the next immediate year like the
Malaysian Dialysis and Transplant Registry (MDTR) but failed to do so for various reasons. One of the major reasons
was a number of participating centres had not sent in their data or if they had sent the data were incomplete. In
future, MRRB hopes to provide data, which is truly a national registry, and also to provide the clinical course of the
biopsied patients.
1.2: Renal biopsies from the participating centres
1.2.1 Ascertainment rate of total biopsy performed
From 2005 to 2010, there were a total of 45 participating centres: 23 centres (15 adult and 8 paediatric) were from
Ministry of Health (MOH), 3 were from universities, 1 from the army and 18 centres were from private hospitals.
All participating centres will be identified by their individual source document provider (SDP) number.
A total of 8624 biopsies were done since 2005 and of these 6249(72.1%) were reported. The ascertainment rate
was 62.6% for 2005, 61.1% for 2006, 74% for 2007, 76.1% for 2008, 74.2% in 2009 and 84.5% for 2010. There
appears to be a progressive improvement in the ascertainment rate. The average ascertainment rate for 20052010 was 72.1%.
2
4th Report of the
Malaysian Registry of Renal Biopsy 2010
Table 1.2.1(a): Total number of biopsy performed and percentage of reported renal biopsies by centres, 2005-2010
2005
Reported
%
100
180
Done
n
97
380
2
480
481
580
680
780
35
89
880
27
96
881
13
77
980
22
96
1080
68
100
1180
11
0
Centre
Done
n
107
2006
Reported
%
100
91
Done
n
101
25
2007
Reported
%
100
100
Done
n
123
85
2008
Reported
%
98
99
Done
n
144
89
2009
Reported
%
95
100
Done
n
171
99
2010
Reported
%
98
100
Done
n
750
311
4th Report of the
Malaysian Registry of Renal Biopsy 2010
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
Total
Reported
%
98
3
100
11
99
100
97
104
100
65
100
57
96
51
100
84
100
461
99
13
100
18
100
19
100
18
100
19
100
19
100
106
100
55
51
45
84
44
88
3
100
0
-
62
97
215
80
30
100
0
-
0
-
0
-
0
-
0
-
30
0
48
94
55
98
50
100
60
100
44
100
293
97
29
97
24
100
24
100
13
100
31
100
148
99
5
100
11
100
11
100
6
100
7
86
53
92
27
100
21
100
22
100
34
97
11
100
137
99
81
100
61
100
94
100
88
100
58
100
450
100
63
67
4
13
32
97
36
83
37
92
211
67
0
-
2
100
7
88
7
0
13
0
0
-
30
30
1280
21
81
33
18
10
40
27
15
11
100
48
19
165
35
1380
15
100
23
100
30
94
37
73
16
68
46
100
169
90
1480
39
100
50
100
44
100
0
-
92
3
85
0
310
44
1780
74
100
101
100
63
100
87
100
75
100
107
100
507
100
2081
42
100
51
100
42
100
55
100
43
100
37
100
270
100
2380
0
-
0
-
0
-
0
-
0
-
28
100
28
100
4380
95
96
141
100
121
90
126
89
156
99
141
100
780
96
4381
16
100
26
92
14
100
17
100
14
86
33
100
120
97
7781
28
100
24
100
37
100
41
100
26
100
35
100
191
100
20080
0
-
84
0
62
0
179
0
80
0
61
0
466
0
20180
193
0
239
0
176
100
179
84
178
28
0
-
965
39
20280
0
-
15
0
22
0
25
0
19
5
18
100
99
19
25280
4
100
2
100
4
100
2
100
2
100
0
-
14
100
60680
10
0
12
0
8
13
12
100
17
35
5
0
64
30
60980
0
-
9
0
12
0
12
0
10
100
8
100
51
35
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
1181
Table 1.2.1(a): Total number of biopsy performed and percentage of reported renal biopsies by centres, 2005-2010 (con’t)
2005
Reported
%
3
Done
n
23
32
2007
Reported
%
22
0
Done
n
28
24
2008
Reported
%
29
17
0
6
0
4
0
61880
20
0
20
0
20
0
62380
48
0
45
0
64
3
62580
1
0
3
0
2
0
2
65480
9
0
8
0
10
0
0
65780
0
-
0
-
8
0
3
65880
13
0
8
0
18
0
17
100
68580
0
-
0
-
0
-
19
100
106881
0
-
0
-
3
100
17
100
6
108180
0
-
29
0
0
-
44
84
69
112780
0
-
0
-
0
-
0
-
0
114580
0
-
0
-
1
0
0
-
0
-
0
-
1
0
121580
0
-
0
-
0
-
0
-
0
-
5
0
5
0
126080
0
-
0
-
0
-
0
-
5
100
57
100
62
100
127780
0
-
0
-
0
-
0
-
9
100
9
100
18
100
1150
63
1534
61
1320
74
1554
76
1528
74
1538
84
8624
72
0
-
Done
n
94
185
Total
Reported
%
40
11
12
-
Done
n
10
23
2010
Reported
%
100
26
61780
10
Done
n
20
17
2009
Reported
%
35
59
61080
61280
4
Total
Done
n
13
52
2006
Reported
%
62
0
Done
n
0
37
Centre
32
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
4th Report of the
Malaysian Registry of Renal Biopsy 2010
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
0
0
0
0
-
12
42
0
-
72
7
65
85
65
100
54
98
341
51
100
3
100
0
-
11
45
-
0
-
0
-
27
0
100
2
50
0
-
13
31
5
100
12
100
73
47
16
100
17
53
52
85
100
7
100
33
100
93
68
90
210
77
-
1
0
1
0
4th Report of the
Malaysian Registry of Renal Biopsy 2010
4th Report of the
Malaysian Registry of Renal Biopsy 2010
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
Table 1.2.1(b): Total number of reported and unreported renal biopsies, 2005-2010
Year
2005
2006
2007
2008
2009
2010
Total
Reported
720
937
977
1182
1134
1299
6249
Not reported
430
597
343
372
394
239
2375
Total performed
1150
1534
1320
1554
1528
1538
8624
Ascertainment rate (%)
62.6
61.1
74.0
76.1
74.2
84.5
72.1
1.2.2 Type of renal biopsy performed
As expected, majority of the biopsies reported were from native kidneys; 90.1% in 2005, 87.4% in 2006, 87.3% in
2007, 89.5% in 2008, 88.3% in 2009 and 86.1% in 2010. Overall, 88% of renal biopsies were from native kidneys
while 12% were from graft kidneys (Table 1.2.2).
5
Table 1.2.2: Distribution of reported native and graft renal biopsies by centre, 2005-2010
2005
Centre
180
2006
2007
2008
2009
2010
Total
Native
n
Graft
n
Native
n
Graft
n
Native
n
Graft
n
Native
n
Graft
n
Native
n
Graft
n
Native
n
Graft
n
Native
n
Graft
n
69
28
57
50
58
43
83
37
103
41
125
42
495
241
6
2
0
10
0
25
0
81
3
86
3
90
9
294
15
480
85
12
93
11
63
2
51
4
49
2
71
13
412
44
481
13
0
17
1
19
0
18
0
19
0
19
0
105
1
580
27
1
36
2
42
2
3
0
0
0
60
0
168
5
780
26
5
34
11
43
12
40
10
51
9
41
3
235
50
880
26
0
27
1
23
1
23
1
11
2
31
0
141
5
881
10
0
5
0
11
0
11
0
6
0
6
0
49
0
980
21
0
25
2
20
1
21
1
33
0
11
0
131
4
1080
68
0
79
2
61
0
93
1
87
1
56
2
444
6
1180
0
0
42
0
4
0
31
0
30
0
34
0
141
0
1181
0
0
2
0
7
0
0
0
0
0
0
0
9
0
1280
17
0
6
0
10
0
4
0
11
0
9
0
57
0
1380
15
0
23
0
30
0
27
0
10
1
46
0
151
1
1480
35
4
47
3
44
0
0
0
3
0
0
0
129
7
1780
72
2
99
2
61
2
82
5
72
3
99
8
485
22
2081
41
1
38
13
33
9
38
17
31
12
27
10
208
62
2380
0
0
0
0
0
0
0
0
0
0
27
1
27
1
4380
73
18
122
19
87
22
97
15
112
43
104
37
595
154
4381
16
0
23
1
14
0
17
0
12
0
32
1
114
2
7781
28
0
24
0
37
0
39
2
25
1
31
4
184
7
20180
0
0
0
0
146
30
124
27
43
7
0
0
313
64
20280
0
0
0
0
0
0
0
0
1
0
18
0
19
0
25280
4
0
2
0
4
0
2
0
2
0
0
0
14
0
60680
0
0
0
0
1
0
12
0
6
0
0
0
19
0
60980
0
0
0
0
0
0
0
0
10
0
8
0
18
0
61080
0
0
8
0
5
0
8
0
7
0
10
0
38
0
61280
1
0
0
0
0
0
4
0
10
0
5
1
20
1
4th Report of the
Malaysian Registry of Renal Biopsy 2010
380
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
4th Report of the
Malaysian Registry of Renal Biopsy 2010
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
4th Report of the
Malaysian Registry of Renal Biopsy 2010
Table 1.2.2: Distribution of reported native and graft renal biopsies by centre, 2005-2010 (con’t)
2005
Centre
2006
2007
2008
2009
2010
Total
Native
Graft
Native
Graft
Native
Graft
Native
Graft
Native
Graft
Native
Graft
Native
Graft
7
n
n
n
n
n
n
n
n
n
n
n
n
n
n
61880
0
0
0
0
0
0
0
0
5
0
0
0
5
0
62380
0
0
0
0
2
0
55
0
65
0
53
0
175
0
62580
0
0
0
0
0
0
2
0
3
0
0
0
5
0
65780
0
0
0
0
0
0
3
0
1
0
0
0
4
0
65880
0
0
0
0
0
0
16
1
5
0
11
1
32
2
68580
0
0
0
0
0
0
19
0
16
0
9
0
44
0
106881
0
0
0
0
3
0
17
0
6
0
7
0
33
0
108180
0
0
0
0
0
0
37
0
61
3
60
1
158
4
126080
0
0
0
0
0
0
0
0
0
5
10
47
10
52
127780
0
0
0
0
0
0
0
0
9
0
9
0
18
0
649
71
819
118
853
124
1058
124
1001
133
1119
180
5499
750
Total
4th Report of the
Malaysian Registry of Renal Biopsy 2010
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
4th Report of the
Malaysian Registry of Renal Biopsy 2010
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.
From 2005 to 2010, a total of 5415 patients underwent native renal biopsy. 4701 (86.8%) patients had renal
biopsy for the first time, 574 (10.6%) patients had biopsy done twice, 120 (2.2%) patients had biopsy done thrice
and 20 (0.4%) patients had four or more biopsies. Therefore about 13.2% of patients had a repeat native biopsy
done (Table 1.2.3(a)).
Over the same period, 585 patients underwent renal allograft biopsy. 342(58.5%) patients had biopsy done once,
148(25.3%) patients had biopsy done twice, 55(9.4%) patients had biopsy done thrice and 40 patients had biopsy
done four times or more (Table1.2.3 (b)). As expected, there was a higher rate of repeat graft biopsies (41.5 %)
compared to native kidneys (13.2%).
Table 1.2.3(a): Distribution of native renal biopsy in patients by number of episodes, 2005-2010
Native
st
1 episode
2005
2006
2007
2008
2009
2010
Total
n
%
n
%
n
%
n
%
n
%
n
%
n
%
559
87.1
704
87.1
731
86.7
919
88.1
847
86.3
941
85.8
4701
86.8
nd
episode
72
11.2
95
11.8
84
10.0
106
10.2
103
10.5
114
10.4
574
10.6
rd
episode
10
1.6
9
1.1
25
3.0
15
1.4
26
2.7
35
3.2
120
2.2
≥4 episode
1
0.2
0
0.0
3
0.4
3
0.3
6
0.6
7
0.6
20
0.4
Total Patient
642
100
808
100
843
100
1043
100
982
100
1097
100
5415
100
2
3
th
Table 1.2.3 (b): Distribution of renal allograft biopsy in patients by number of episodes/attempts, 2005-2010
2005
Graft
2006
2007
2008
2009
2010
Total
n
%
n
%
n
%
n
%
n
%
n
%
n
%
1st episode
48
77.4
70
69.3
60
63.2
54
52.4
52
50.0
58
48.0
342
58.5
2nd episode
11
17.7
21
20.8
22
23.2
32
31.1
32
30.8
30
25.0
148
25.3
3 episode
3
4.8
7
6.9
9
9.5
10
9.7
11
10.6
15
12.5
55
9.4
≥4th episode
0
0.0
3
3.0
4
4.2
7
6.8
9
8.7
17
14.2
40
6.8
Total Patient
62
100
101
100
95
100
103
100
104
100
120
100
585
100
rd
8
4th Report of the
Malaysian Registry of Renal Biopsy 2010
OVERVIEW OF RENAL BIOPSY IN MALAYSIA
1.2.4: Demographic distribution of renal biopsy (Native and Graft)
1.2.4.1: Age distribution
About 84.2% 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 age. Very few (7.4%) biopsies were done in patients older than 55
years old. (Table 1.2.4.1 (a))
In the graft biopsy group, 95.1% were done in patients older than 15 years old and of these, 89.1% were in the age
group of 15 to less than 55 years. Only 10.4% 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 Selangor (23.2%); followed by
Wilayah Persekutuan Kuala Lumpur (22.9%) and Penang (11.7%). In the paediatric group (age < 15 years old), the
highest number of renal biopsy were reported in WP Kuala Lumpur (27.2%); followed by Johor (21.6%) and Selangor
(16.4%). (Table1.2.4.1 (c))
Table 1.2.4.1(a): Age distribution of native renal biopsy, 2005-2010
Age group
(years)
2005
n
2006
n
2007
n
2008
n
2009
n
2010
n