24 Himawan Med J Indones
Pathological features of glomerulonephritis in Jakarta
Sutisna Himawan
Abstrak
Semua knsus biopsi ginjal yang diterima selama l0 tahun dari 1990-1999 dikumpulkan dan diteliti. Seluruhnya terdapat 1344 kasus,
terdiri atas 390 kasus pediatrik, 918 k"asus dewasa dan 36 kasus yang usianya tidak diketahui. Tujrcn penelitian ini inlah untuk
mendapatkan gambaran tentanç pola dnn spektrum penyakit glomerulus di Indonesia, terutama di Jaknrta dan sekitarnya, dengan
perhatian khusus pada kasus sindrom nefrotik, nefritis lupus dan nefropati IgA, serta membandingkannya dengan berbagai laporan
terdahulu dari Indonesia dan beberapa negara lain. Terdapat 250 kasus sindrom nefrotik pada anak dnn 479 kasus dewasa.
Diagnosis histopatologik yang paling seing pada kedua golongan ialah penyakit kelainan minimal, yaitu masing-masing sebanyak
58.2Vo dan 44.7Va. Pia lebih seing terkena daripada wanita dengan perbandingan untuk masing-mnsing golongan iatah 2.0: I dan L4: I.
Nefritis lupus meliputi 124 knsus, tiga diantaranya tidak representatif. Perbandingan pia terhndap wanita ialah l:7.9. Frekaensi puncak
tcrdapat pada dekade keempat sebanyak 47 kqsus (38.5Eù dan garnbaran histopatologik terbanyak iaLah WHO kelas IV, yaitu 71 kasus
(58.7Vo). Diagnosis nefropati IgA ditegakkan pada 97 kasus. Sebaran usia dari 3 hingga 58 tahun dengan puncak insidens pada dekade
keempat dengan 32 kasus (337o). Pia lebih sertng dari wanita dengan perbandingan 1.7: I. Gambaran histopatologik terbanyak ialah lesi
sklerosis difus 34 knsus ( j5Vo) dan lesi proliferatif mesangial 33 kasus (34Vo). (Med J Indones 2002; 11: 24-9)
Abstract
AII cases of renal biopsies received during a 1)-year periodfrom 1990-1999 were collected and analyzed. There were a totat of 1344
cases, comprising 390 pediatric cases, 9 I 8 adult cases and 36 cases of unlotown age. Immunofluorescence microscopy was performed
on 1089 cases (8L0Vo). The purpose of this study is to have an overview of the pattem and spectrum of gLomerular diseases in
Indonesia, especially in Jakarta and surroundings, with special emphasis on the cases with nephrotic syndrome, lupus nephritis and
IgA nephropathy, and to compare the findings with previous reports from Indonesia and afew other countries. There were 250 cases
of childhood nephrotic syndrome and 479 adult cases. The most frequent histopathological appearance in both groups was minimal
change disease, i.e. 58.2Vo and 44.7Vo respectively. Males were more often affected than females with a ratio of 2.0:1 for children and
L4:1 for adults. Lupus nephritis comprised 124 cases, among which three cases were not representative. The male to female ratio was
I:7.9. Most cases were in the fourth decade, i.e. 47 cases (38.580), and the most frequent histopathological appearance was WHO
class IV with 7 I cases (58.7Eo). There were 97 cases of IgA nephropathy with an age range betvveen 3 to 58 years. The peak incidence
was in the fourth decade with 32 cases ( 3 3 7o). The male to female ratio was L7: I. The most frequent histopathological appearances
were dffise sclerosing lesion 34 cases (35Vo) and mesangial proliftrative lesion 33 cases (34%). (Med J Irulones 2002; l1: 24-9)
Keywords: renal biopsy, pathologicalfeatures, glomerulonephritis, nephrotic syndrome, Iupus nephritis, IgA nephropathy
The first report of pe utaneous renal biopsy in
Jakarta was published b Sutedjo and V/ahidijatr in
1963. They described the histopathological findings in
three cases of children with nephrotic slmdrome.
However, due to lack of facilities and various other
reasons the renal biopsies were discontinued and only
in 1970 it was started again.2 Since then it became a
routine procedure in the Sub-departments of Nephrology
Department of Anatomic Pathology, Faculty of Medicine
University of Indonesia/Dr. Cipto M angunkusumo Hospital,
Jakarta, Indonesia
Presented at the L3th Asian Colloquium in Nephrology, Bali,
November 23-25, 2000
of the Department of Child Health and rhe
Department of Internal Medicine of the Faculty of
Medicine University of Indonesia.IDr. Cipto Mangun-
kusumo National Central General Hospital. At that
time the only private hospital which also performed
this procedure was the Cikini Hospital, who had
developed a very solid nephrology team. Nowadays it
is also performed sporadically in a few other private
hospitals. Besides percutaneous renal biopsy, in a part
of the cases an open renal biopsy was performed to
avoid the possibility of an unrepresentative specimen.
During the early 1970s the pathological diagnosis of
renal biopsies was only based on light microscopy
