Kidney Week

Abstract: FR-PO987

Histopathologic and Clinical Characteristics of Nephropathies in Burmese Refugees

Session Information

• Pathology and Lab Medicine - 1
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Pathology and Lab Medicine

• 1800 Pathology and Lab Medicine

Authors

• Hyaduck, Hannah S., Indiana University Health Inc, Indianapolis, Indiana, United States

Hannah S. Hyaduck, MD

• Nunuk, Irene, Indiana University Health Inc, Indianapolis, Indiana, United States

Irene Nunuk, MD

• Guo, Shunhua, Indiana University Health Inc, Indianapolis, Indiana, United States

Shunhua Guo, MD

• Phillips, Carrie L., Indiana University Health Inc, Indianapolis, Indiana, United States

Carrie L. Phillips, MD

• Eadon, Michael T., Indiana University Health Inc, Indianapolis, Indiana, United States

Michael T. Eadon, MD, FASN

• Hata, Jessica Lynn, Indiana University Health Inc, Indianapolis, Indiana, United States

Jessica Lynn Hata, MD, MS

Background

Understanding the spectrum of nephropathies among cultural minorities may be beneficial for nephrologists and pathologists serving multicultural communities. Myanmar (formerly Burma) has been challenged by natural disasters, civil war, poverty, oppression, and human rights violations, displacing many Burmese people to the United States. This population continues to experience limited access to healthcare and poor health outcomes.

Methods

We identified 50 kidney core biopsies from 48 Burmese patients from 2006-2024. The biopsies were examined by light (LM), immunofluorescence (IF), and electron (EM) microscopy using conventional methods. Biopsies were scored by LM using the Oxford Criteria. Podocyte foot process effacement was assessed by EM.

Results

20 patients were male and 28 were female with a mean age of 32.5 years (range 11-53 years). 34 (71%) had IgA nephropathy (IgAN), 10 (21%) had Lupus nephritis (LN), and 4 (8%) had minimal change disease, amyloidosis, thrombotic microangiopathy, or acute tubular necrosis. Most patients with IgAN presented with hematuria and proteinuria. The average urine protein-creatinine ratio was 3.8 grams with a median creatinine of 0.92 mg/dL. 35% had hypertension with rare other comorbidities; the average body mass index was 24.4 kg/m². Additional findings in IgA patients included increased rates of segmental sclerosis (S1, 71%) and mesangial hypercellularity (M1, 71%), endocapillary hypercellularity and crescent formation (E1 16% and C1 19%, respectively), and no cases with >25% crescents. Tubulointerstitial fibrosis was mild overall (68% T0, 19% T1). Podocyte injury was prominent with 41% of cases showing >50% foot process effacement and 26% with glomerular collapsing features, tubular microcystic change, and/or increased tubular protein resorption droplets. Moderate and severe arterial and arteriolosclerosis were present at 43% and 44%, with 35% showing moderate to severe hyalinosis.

Conclusion

Burmese patients with IgAN had greater than expected rates of segmental sclerosis, podocyte injury, proteinuria, and vascular disease, raising the possibility of an underlying genetic predisposition to podocyte and endothelial injury. Advancing our understanding of the nephropathy spectrum in Burmese immigrant patients may lead to improved strategies for disease prevention and management.