Abstract
BACKGROUND: Glomerular diseases are a major contributor to chronic kidney disease, with regional variability influenced by genetic, environmental, and healthcare factors. In Northwest India, minimal change disease (MCD) was historically the most common primary glomerular disease (PGD). However, evolving diagnostic capabilities and the disruptions caused by the COVID-19 pandemic may have altered the landscape of glomerular disease presentations and biopsy practices.
OBJECTIVES: To reassess the clinicopathologic spectrum of glomerular diseases from 2020 to 2024, compare it with data from 2008 to 2013, and evaluate the impact of the COVID-19 pandemic on biopsy activity and disease distribution.
METHODOLOGY: We retrospectively analyzed 925 renal biopsies from 2020 to 2024 and compared them with 622 biopsies from 2008 to 2013. All samples underwent light microscopy (LM) and immunofluorescence (IF) staining (IgA, IgG, IgM, C3, and C4). Diagnoses were categorized into PGD, secondary glomerular disease (SGD), and others. Clinical presentations, including nephrotic syndrome (NS) and acute kidney injury (AKI), were recorded. Statistical comparisons were made using Chi-square (χ2) and Z-tests (SPSS v29), with p < 0.05 considered significant.
RESULTS: Glomerulonephritis remained predominant (93.9%) with a significant shift in distribution (χ2 = 121.5, p < 0.0001). IgA nephropathy increased from 7.4 to 15.4%, overtaking MCD (which declined from 21.1 to 8.1%) as the leading PGD. Focal segmental glomerulosclerosis (FSGS) rose to 12.4%, while diabetic nephropathy (DN) increased to 3.1%. Nephrotic syndrome was the most common presentation (59.3%). Biopsy volume declined by 60% in 2020 but rebounded by 2022.
CONCLUSION: These findings highlight evolving diagnostic trends and underscore the need for broader biopsy access, enhanced diagnostic tools, and a national renal biopsy registry in India.