Challenges in Diagnosis and Management of Glomerular Disease in Resource-Limited Settings

Ramachandran, Raja; Sulaiman, Shabna; Chauhan, Pooja; Ulasi, Ifeoma; Onu, Ugochi; Villaneuva, Russell; Alam, Muhammad Rafiqul; Akhtar, F.; Vincent, Lloyd; Aulakh, Gurmehar S.; Sutranto, Aida Lydia; Zakharova, Elena; Jha, Vivekanand

doi:10.1016/j.ekir.2022.07.002

Cited by 8 publications

(10 citation statements)

References 18 publications

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“…Lack of capacity to undertake and evaluate kidney biopsy, unavailability of ancillary serologic tests, lack of trained nephrologists and nephropathologist, and lack of access to immunosuppressive agents and renal replacement therapy are some of the barriers to implementing this evidence‐based guideline. 20 Clinicians in resource‐limited settings diagnose RPGN mostly based on clinical ground and locally available ancillary serologic tests. Despite this limitation in accurate diagnosis, a significant proportion ends up being treated empirically with an immunosuppressive agent.…”

Section: Discussionmentioning

confidence: 99%

“…Although guidelines for the diagnosis and treatment of RPGN exist, it is infrequently implemented in resource‐limited settings. Lack of capacity to undertake and evaluate kidney biopsy, unavailability of ancillary serologic tests, lack of trained nephrologists and nephropathologist, and lack of access to immunosuppressive agents and renal replacement therapy are some of the barriers to implementing this evidence‐based guideline 20 . Clinicians in resource‐limited settings diagnose RPGN mostly based on clinical ground and locally available ancillary serologic tests.…”

Section: Discussionmentioning

confidence: 99%

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Atypical presentation of syphilis: Rapidly progressive glomerulonephritis

Usmael

Gebremedhin

2023

Clinical Case Reports

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Syphilis is a sexually transmitted disease with a wide range of clinical manifestations. With the recent worldwide resurgence of syphilis, it is imperative to recognize various presentations of this great imitator. Renal syphilis is rare and most commonly present as nephrotic range proteinuria associated with pathological features of membranous glomerulonephritis. Rapidly progressive glomerulonephritis (RPGN) is a rare and atypical form of renal syphilis. A 50‐year‐old Ethiopian woman presented with periorbital swelling, hematuria, proteinuria, and rapidly progressive renal failure. Rapid plasma reagin and confirmatory Treponema pallidum hemagglutination (TPHA) tests were reactive. Treatment with a weekly Benzathine penicillin for 3 weeks resulted in a rapid return of renal function to baseline, with the increasing rate of new syphilis, clinicians should be mindful of the various renal manifestation of syphilis. This case highlights the significance of considering syphilis as a reversible cause in any patient presenting with a clinical feature suggestive of RPGN.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Atypical presentation of syphilis: Rapidly progressive glomerulonephritis

Usmael

Gebremedhin

2023

Clinical Case Reports

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“…However, there is a widespread lack of facilities for immunofluorescence and electron microscopy in sub-Saharan Africa, and the practice of kidney biopsy is still not well-developed among renal care practitioners in many countries in sub-Saharan Africa [ 19 , 56 , 67 ]. A recent study that assessed challenges in the diagnosis and management of glomerular diseases in resource-limited settings (mainly Africa and Asia) reported major system-level barriers that impede the implementation of guideline-driven approaches for the diagnosis and treatment of patients with glomerular disease [ 68 ]. These barriers included a low performance of kidney biopsies, cost of diagnostic work-up (e.g.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and distribution of primary glomerular diseases in Africa: a systematic review and meta-analysis of observational studies

Ekrikpo,

Obiagwu,

Udo

et al. 2023

Pan Afr Med J

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Glomerulonephritis (GN) is a predominant cause of kidney failure in Africa. The prevalence of primary GNs varies widely across Africa depending on the relative proportion of secondary GNs and genetic predispositions. We assessed the overall and sub-regional prevalence of primary GN and its histologic subtypes in Africa. We searched PubMed, EMBASE and African Journals Online for studies of biopsy-proven primary GNs across all age groups in Africa published between 2010 and 2022. Data for primary GNs [minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), membranous nephropathy (MN), mesangioproliferative GN (MesPGN), membranoproliferative GN (MPGN), post-infectious GN (PIGN), IgA Nephropathy (IgAN), and crescentic GN (CresGN)] were extracted. Pooled prevalence was determined using the random effects model. Seventeen eligible articles (n = 6,494 individuals) from 8 African countries met the inclusion criteria. The overall pooled prevalence of FSGS, MCD, MN, MPGN, MesPGN, PIGN, IgAN and CresGN was 26.10%, 22.40%, 8.40%, 6.40%, 6.40%, 2.60%, 2.60%, 1.40%, respectively. Only 4 studies (23.5%) used light microscopy (LM), immunofluorescence (IF), and electron microscopy (EM) for diagnosis. There were significant differences in the distribution of histologic subtypes in the paediatric compared to the adult population and across geographic sub-regions, with West Africa having a higher prevalence of FSGS. Overall, the dominance of FSGS across most regions and age groups has implications for disease diagnosis and ongoing care. Research efforts to understand the impact of this trend on kidney disease outcomes and efforts to improve kidney biopsy practice as a means of early disease detection are needed in Africa.

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“…Diagnosis of rare kidney diseases is problematic and has historically relied on kidney biopsies, which have shortcomings (invasive, risk of bleeding, insufficient sample size for diagnosis, limitations in access to histologic techniques and expertise for interpretation, and limited prognostic value) and are not systematically used. 12 Patients with rare kidney diseases often spend years visiting multiple health care providers before receiving an accurate diagnosis. Next-generation sequencing techniques are emerging as the new diagnostic standard for genetic rare kidney diseases as they noninvasively amplify diagnostic accuracy, help decipher molecular mechanisms, allow genetic counseling, and offer possibilities for carrier testing.…”

Section: Diagnosismentioning

confidence: 99%

A Policy Call to Address Rare Kidney Disease in Health Care Plans

Vanholder

Coppo

Bos

et al. 2023

CJASN

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Despite a large number of people globally being affected by rare kidney diseases, research support and health care policy programs usually focus on the management of the broad spectrum of CKD without particular attention to rare causes that would require a targeted approach for proper cure. Hence, specific curative approaches for rare kidney diseases are scarce, and these diseases are not treated optimally, with implications on the patients' health and quality of life, on the cost for the health care system, and society. There is therefore a need for rare kidney diseases and their mechanisms to receive the appropriate scientific, political, and policy attention to develop specific corrective approaches. A wide range of policies are required to address the various challenges that target care for rare kidney diseases, including the need to increase awareness, improve and accelerate diagnosis, support and implement therapeutic advances, and inform the management of the diseases. In this article, we provide specific policy recommendations to address the challenges hindering the provision of targeted care for rare kidney diseases, focusing on awareness and prioritization, diagnosis, management, and therapeutic innovation. In combination, the recommendations provide a holistic approach aiming for all aspects of rare kidney disease care to improve health outcomes, reduce the economic effect, and deliver benefits to society. Greater commitment from all the key stakeholders is now needed, and a central role should be assigned to patients with rare kidney disease to partner in the design and implementation of potential solutions.

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Challenges in Diagnosis and Management of Glomerular Disease in Resource-Limited Settings

Cited by 8 publications

References 18 publications

Atypical presentation of syphilis: Rapidly progressive glomerulonephritis

Atypical presentation of syphilis: Rapidly progressive glomerulonephritis

Prevalence and distribution of primary glomerular diseases in Africa: a systematic review and meta-analysis of observational studies

A Policy Call to Address Rare Kidney Disease in Health Care Plans

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