1. CHAPTER 1 Overview of Renal Biopsy in Malaysia Wan Sha’ariah Md Yusuf Lee Ming Lee Lee Day Guat

2. Table 1.2.1: Total number of biopsy performed and percentage of reported renal biopsies by centres, 2005-2010 4 th MRRB report 2010, Malaysia

3. Table 1.2.1: Total number of biopsy performed and percentage of reported renal biopsies by centres, 2005-2010 (con’t)

4. Table 1.2.1(b): Total number of reported and unreported renal biopsies, 2005-2010 4 th MRRB report 2010, Malaysia Year20052006200720082009 2010 Total Reported7209379771182113412996249 Not reported4305973433723942392375 Total performed1150153413201554152815388624 Ascertainment rate (%)62.661.17476.174.284.572.1

5. Table 1.2.2: Distribution of reported native and graft renal biopsies by centre, 2005-2010 4 th MRRB report 2010, Malaysia

6. Table 1.2.2: Distribution of reported native and graft renal biopsies by centre, 2005-2010 (cont.)

7. Table 1.2.3(a): Distribution of native renal biopsy in patients by number of episodes, 2005-2010 4 th MRRB report 2010, Malaysia Native 200520062007200820092010Total n%n%n%n%n%n%n% 1 st episode559877048773187919888478694186470187 2 nd episode72119512841010610103111141057411 3 rd episode101.691.1253151.4262.7353.21202.2 ≥4 th episode10.20030.430.360.67 200.4 Total Patient6421008081008431001043100982100 109 71005415100

8. Table 1.2.3 (b): Distribution of renal allograft biopsy in patients by number of episodes/attempts, 2005-2010 4 th MRRB report 2010, Malaysia Graft 200520062007200820092010Total n%n%n%n%n%n%n% 1 st episode4877.47069.36063.25452.45250584834258.5 2 nd episode1117.72120.82223.23231.13230.8302514825.3 3 rd episode34.876.999.5109.71110.61512.5559.4 ≥4 th episode003344.276.898.71714.2406.8 Total Patient6210010110095100103100104100120100585100

9. Table 1.2.4.1(a): Age distribution of native renal biopsy, 2005-2010 Age group (years) 200520062007200820092010Total nnnnnnn% <1512813714516513715786915.8 15-<24173237226308295307154628.1 25-<35143183194227 254122822.3 35-<4511612613214315618786015.6 45-<555982911359912559110.7 55-<651841445148672694.9 > 651213212939221362.5 Total6498198531058100111195499100 4 th MRRB report 2010, Malaysia

10. Table 1.2.4.1(b): Age distribution of renal allograft biopsy, 2005-2010 Age group (years) 200520062007200820092010Total nnnnnnn% <15057988374.9 15-<2515261922182112116.1 25-<3511251520302913017.3 35-<4523264925246621328.4 45-<551224 35364017122.8 55-<65881091612638.4 > 65240414152.0 Total71118124 133180750100 4 th MRRB report 2010, Malaysia

11. Table 1.2.4.1(c): Age group distribution of reported renal biopsies by state, 2005-2010 Year of biopsy200520062007 Age gp (years)Age < 15Age ≥ 15Age < 15Age ≥ 15Age < 15Age ≥ 15 Staten%n%n%n%n%n% Johor2922.76711.32416.98110.24529.6536.4 Kedah00.020.300.0101.342.6212.5 Kelantan21.6132.200.0232.921.3283.4 Melaka21.6193.221.4253.110.7202.4 N.Sembilan118.6254.26 273.4106.6253.0 Pahang00.00 64.2384.853.360.7 Perak32.3294.921.4384.800.0495.9 Perlis00.00 0 0 0 0 Penang1410.99616.21812.710413.11912.5678.1 Sabah10.8386.453.5455.753.3425.1 Sarawak64.76811.585.610112.742.6647.8 Selangor1713.312120.42920.418122.81711.216119.5 Terengganu21.6152.510.750.600.0101.2 WP KL4132.09916.74128.911714.74026.327933.8 Total128100592100142100795100152100825100 4 th MRRB report 2010, Malaysia

12. Year of biopsy200820092010Total Age groupAge < 15Age ≥ 15Age < 15Age ≥ 15Age < 15Age ≥ 15Age < 15Age ≥ 15 Staten%n%n%n%n%n%n%n% Johor3922.4969.53121.4888.92817938.219621.64788.9 Kedah31.7838.221.4909.174.2928.1161.82985.6 Kelantan31.7242.410.7111.153595.2131.41583 Melaka10.6212.110.7323.20011170.81282.4 N.Sembilan126.9232.374.8121.263.6312.7525.71432.7 Pahang10.630332.1363.610.6423.7161.81522.8 Perak00171.70080.810.6595.260.72003.7 Perlis0000000000000000 Penang1810.311010.92315.911211.32213.313411.811412.662311.7 Sabah158.620.264.130.374.200394.31302.4 Sarawak95.2868.5117.6818.2116.711410.1495.45149.6 Selangor2614.922622.42114.529129.43923.62612314916.4 124 123.2 Terengganu0040.400111.10090.830.3541 WP KL472728628.43926.921421.6382322920.224627.2 122 422.9 Total174100100810014510098910016510011341009061005343100 4 th MRRB report 2010, Malaysia Table 1.2.4.1(c): Age group distribution of reported renal biopsies by state, 2005-2010 (cont.)

13. Table 1.2.4.2(a): Gender distribution of native renal biopsy, 2005-2010 Gender 200520062007200820092010Total nnnnnnn% Male237341323430398444217340.1 Female405467520613584653324259.9 Total642808843104398210975415100 4 th MRRB report 2010, Malaysia

14. Table 1.2.4.2(b): Gender distribution of renal allograft biopsy, 2005-2010 Gender 200520062007200820092010Total nnnnnnn% Male39655962697637063.2 Female2336 41354421536.8 Total6210195103104120585100 4 th MRRB report 2010, Malaysia

15. Table 1.2.4.3(a): Racial distribution of native renal biopsy, 2005-2010 Race 200520062007200820092010Total nnnnnnn% Malay357456459582581668310357.3 Chinese159196237277248269138625.6 Indian46596170 533596.6 Others8097861148310756710.5 Total642808843104398210975415100 4 th MRRB report 2010, Malaysia

16. Table 1.2.4.3(b): Racial distribution of renal allograft biopsy, 2005-2010 4 th MRRB report 2010, Malaysia Race 200520062007200820092010Total nnnnnnn% Malay17273238314118631.8 Chinese36614947605931253.3 Indian510911912569.6 Others435748315.3 Total6210195103104120585100

17. Table 1.2.5: Number of glomeruli obtained at each biopsy by centres, 2005-2010 4 th MRRB report 2010, Malaysia

18. Table 1.2.6 (a): Distribution of biopsy specimens to local histopathology laboratories by participating centres, 2005-2010 4 th MRRB report 2010, Malaysia

19. Table 1.2.6(b): Distribution of biopsy specimens to outside histopathology laboratories by participating centres, 2005-2010 4 th MRRB report 2010, Malaysia

20. Table 1.2.6(b): Distribution of biopsy specimens to outside histopathology laboratories by participating centres, 2005-2010 (cont.)

21. Table 1.2.6(c): Summary of biopsies received by local and external laboratories, 2007-2010 2007 (1 st report)2008 (2 nd report)2009 (3 rd Report)2010 (4 th Report) n%n%n%n% Local Lab 108544.9179947.6236048.5298447.8 External Lab 133455.1197852.4250651.5326552.2 All Lab 2419 1003777 1004866100 6249 100 4 th MRRB report 2010, Malaysia

22. Table 1.2.6 (d): Histopathology laboratories receiving renal biopsy specimens, 2005-2010 4 th MRRB report 2010, Malaysia

23. Table 1.3.1(a): Indications for native renal biopsies, 2005-2010 4 th MRRB report 2010, Malaysia Clinical Presentation 200520062007200820092010Total n%n%n%n%n%n%n% Asymptomatic urine abnormality 16825.921826.623627.732130.327727.736732.8158728.9 Nephritic syndrome 629.6688.3728.4918.6848.4867.74638.4 Nephrotic syndrome 31047.837345.539446.246944.34204245640.8242244 Nephrotic-Nephritic syndrome 213.2384.6536.21039.713713.713111.74838.8 Not available/ Missing 8813.612214.99811.5747838.3797.15449.9 Total6491008191008531001058100100110011191005499100

24. Table 1.3.1(b): Renal function at time of biopsy, 2005-2010 Renal function 200520062007200820092010Total n%n%n%n%n%n%n% Normal 36155.641650.847555.758054.849549.558151.92,90852.9 Impaired 15023.123929.229334.340037.84304346041.11,97235.9 Not available/ Missing 13821.3164208510787.4767.678761911.3 Total6491008191008531001058100100110011191005499100 4 th MRRB report 2010, Malaysia

25. Table 1.3.2: Histopathology of all native renal biopsies, 2005-2010 4 th MRRB report 2010, Malaysia

26. Table 1.3.2: Histopathology of all native renal biopsies, 2005-2010 (cont.)

27. Table 1.3.3.1: HPE diagnosis in patients presenting with Nephritic Syndrome, 2005-2010 *Patients may have either one or more histopathology or not have any histopathology Others = Tubulo. Disease + Vascular + Advance GN + Others + Hereditary (no observation) 4 th MRRB report 2010, Malaysia TypeHistopathological Diagnosisn% Primary GN Minimal Change 66627.1 FSGS 53621.8 lg A nephropathy 1174.8 Membranous nephropathy 1385.6 Membrano-proliferative 241 Mesangial Proliferative GN-non IgA 371.5 Crescentic 00 Idiopathic crescentic 70.3 Not available/Missing 160.6 Sub total 154162.6 Secondary GN Other infection 60.2 Lupus Nephritis 56222.8 Henoch Schonlein Purpura 30.1 HUS/TTP 10 Amyloidosis 60.2 Systemic vasculitis 10 Post infection GN 130.5 Polyarteritis nodosa 00 Malignancy 10 Light/ heavy chain disease 10 Diabetic nephropathy 953.9 Anti GBM 00 Immunotactoid / fibrillary GN 00 Multiple myeloma 10 Not available/Missing 90.4 Sub total 69928.4 Others2229 Total2462100

28. Table 1.3.3.2: HPE diagnosis in Patients presenting with Asymptomatic Urine Abnormalities, 2005-2010 * Patients may have either one or more histopathology or not have any histopathology Others = Tubulo. Disease + Vascular + Advance GN + Others + Hereditary 4 th MRRB report 2010, Malaysia TypeHistopathological Diagnosisn% Primary GN Minimal Change956.1 FSGS1479.4 lg A nephropathy23615.1 Membranous nephropathy462.9 Membrano-proliferative40.3 Mesangial Proliferative GN-non IgA281.8 Crescentic40.3 Idiopathic crescentic100.6 Not available/Missing90.6 Sub total57937.1 Secondary GN Other infection20.1 Lupus Nephritis69744.7 Henoch Schonlein Purpura181.2 HUS/TTP00 Amyloidosis30.2 Systemic vasculitis10.1 Post infection GN171.1 Polyarteritis nodosa00 Malignancy00 Light/ heavy chain disease10.1 Diabetic nephropathy412.6 Anti GBM00 Immunotactoid / fibrillary GN00 Multiple myeloma40.3 Missing30.2 Sub total78750.4 Others 19412.4 Total 1560100

29. Table 1.3.3.3 : HPE diagnosis in patients presenting with Nephritic-Nephrotic, 2005-2010 * Patients may have either one or more histopathology or not have any histopathology Others = Tubulo. Disease + Vascular + Advance GN + Others + Hereditary (no observation) 4 th MRRB report 2010, Malaysia TypeHistopathological Diagnosisn% Primary GN Minimal Change346.6 FSGS418 lg A nephropathy407.8 Membranous nephropathy71.4 Membrano-proliferative81.6 Mesangial Proliferative GN-non IgA61.2 Crescentic10.2 Idiopathic cresentic51 Sub total14227.7 Secondary GN Other infection30.6 Lupus Nephritis24748.1 Henoch Schonlein Purpura51 HUS/TTP00 Amyloidosis00 Systemic vasculitis20.4 Post infection GN254.9 Polyarteritis nodosa00 Malignancy10.2 Light/ heavy chain disease00 Diabetic nephropathy163.1 Anti GBM00 Immunotactoid / fibrillary GN00 Multiple myeloma10.2 Missing10.2 Sub total30158.7 Others 7013.6 Total 513100

30. Table 1.3.3.4: HPE diagnosis in Patients presenting with Nephritic syndrome, 2005-2010 * Patients may have either one or more histopathology or not have any histopathology Others = Tubulo. Disease + Vascular + Advance GN + Others + Hereditary 4 th MRRB report 2010, Malaysia TypeHistopathological Diagnosisn% Primary GN Minimal Change306.5 FSGS408.6 lg A nephropathy398.4 Membranous nephropathy30.6 Membrano-proliferative71.5 Mesangial Proliferative GN-non IgA81.7 Crescentic40.9 Idiopathic cresentic91.9 Unknown40.9 Sub total14431 Secondary GN Other infection00 Lupus Nephritis20243.4 Henoch Schonlein Purpura51.1 HUS/TTP00 Amyloidosis10.2 Systemic vasculitis40.9 Post infectious GN347.3 Polyarteritis nodosa00 Malignancy00 Light/ heavy chain disease00 Diabetic nephropathy112.4 Anti GBM10.2 Immunotactoid / fibrillary GN00 Multiple myeloma00 Sub total25855.5 Others 6313.5 Total 465100

31. Table 1.3.3.5 : Table for Primary Glomerulonephritis, 2005-2010 4 th MRRB report 2010, Malaysia

32. Figure 1.3.3.5: Primary gromerulonephritis according to the various age group, 2005-2010