86 March 2014 / Vol 24 / Issue 2 Indian Journal of Nephrology patients in India now have diabetic nephropathy as their underlying etiology. According to the recently published report of Indian National CKD registry, diabetic nephropathy accounts for 31.3% of CKD while glomerulonephritis is the second most common cause. [3] Glomerular diseases in tropical countries is vastly different in epidemiology, etiology and natural history from those seen in temperate countries; and their prevalence also varies according to socio-economic conditions, race, age and indications for renal biopsy. [1] Over the last few years, studies have shown a changing pattern of these diseases. Previous studies showed that membranous glomerulonephritis (MGN) was the most common cause of adult nephrotic syndrome in the United States and Europe. [4] However, more recent studies have shown that the focal segmental glomerulosclerosis (FSGS) is increasing significantly and it has become the most common glomerular disease in African-Americans and Hispanic populations. [4,5] Some studies from India have shown declining incidence of mesangiocapillary glomerulonephritis (MPGN) along Introduction Chronic glomerulonephritis, until recently has been the most common cause of chronic kidney disease (CKD) in developing countries like India. [1,2] However, with the increase in diabetes mellitus, the majority of CKD Original Article Changing histologic spectrum of adult nephrotic syndrome over ive decades in north India: A single center experience M. Rathi, R. L. Bhagat, P. Mukhopadhyay, H. S. Kohli, V. Jha, K. L. Gupta, V. Sakhuja, K. Joshi 1 Departments of Nephrology and 1 Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India ABSTRACT Glomerular diseases are an important cause of chronic renal failure in developing countries. The spectrum of diseases causing nephrotic syndrome is changing globally in the last few decades. The aim of this prospective study was to look at this spectrum at a tertiary care center in North India and to analyze the changing trends over the last ive decades. Patients in the age group 18-60 years with nephrotic syndrome were consecutively included in the study. Renal biopsies were performed in all patients and were subjected to light microscopy, immunoluorescence (IF) and electron microscopy (EM). While the IF was performed in 78% of cases, EM was available in one-fourth of cases. During 2002-2007, 364 patients (60.2% males) were included in the study. The mean age was 31.5 years. Primary glomerular diseases accounted for 89% of cases while lupus nephritis was the most common secondary glomerular disease. Focal segmental glomerulosclerosis (FSGS) accounted for 30.6% of primary glomerular diseases making it the most common cause of nephrotic syndrome. It was followed by membranous glomerulonephritis (MGN) in 24.4%, mesangiocapillary glomerulonephritis in 17.9% and minimal change disease in 14.8%. In the age group >40 years, MGN was the most common lesion (32.5%) followed by FSGS (27.7%). Over the last ive decades, there was a nearly ive‑fold increase in the incidence of FSGS, 3-fold increase in MGN and a 10-fold reduction in diffuse proliferative glomerulonephritis while there was no major change in incidence of other diseases. The biopsy diagnosis of FSGS has increased considerably in last few decades and it is now the most common cause of nephrotic syndrome in adults in North India. MGN is the most common lesion in patients over 40 years of age. Key words: Chronic kidney disease, focal segmental glomerulosclerosis, idiopathic nephrotic syndrome, membranous nephropathy, minimal change disease, renal biopsy Address for correspondence: Dr. Vinay Sakhuja, Department of Nephrology, Post Graduate Institute of Medical Education and Research, Sector‑12, Chandigarh ‑ 160 012, India. E‑mail: vsakhuja2009@gmail.com Access this article online Quick Response Code: Website: www.indianjnephrol.org DOI: 10.4103/0971-4065.127892 [Downloaded free from http://www.indianjnephrol.org on Monday, March 03, 2014, IP: 182.74.79.142] || Click here to download free Android application for this journ