Pattern of glomerular disease in the Saudi population: A single-center, five-year retrospective study

Abstract

Glomerular diseases continue to be the leading cause of end-stage renal disease (ESRD) globally. Hence, it is important to recognize the pattern of glomerular diseases in different geographical areas in order to understand the patho-biology, incidence and progression of the disorder. Published studies from different centers in Saudi Arabia have reported contradicting results. In this retrospective study, we report our experience at the Armed Forces Hospital, Riyadh, Saudi Arabia. A total of 348 native renal biopsies performed at our center on patients with proteinuria >1 g, hematuria and/or renal impairment during a period of 5 years (between January 2005 and December 2009) were studied by a histopathologist using light microscopy, immunofluorescence and electron microscopy, and were categorized. Results showed that primary glomerular disease accounted for 55.1% of all renal biopsies. The most common histological lesion was focal and segmental glomerulosclerosis (FSGS) (27.6%), followed by minimal change disease (MCD) (17.7%) and membrano-proliferative glomerulonephritis (MPGN) (13.0%). Secondary glomerular disease accounted for 37.9% of the glomerular diseases, with lupus nephritis (LN) being the most common lesion (54.5%), followed by hypertensive nephrosclerosis (22%), post-infectious glomerulonephritis (7.5%), diabetic nephropathy (DN) (6.8%) and vasculitides (4.5%). Four percent of all biopsies turned out to be ESRD while biopsy was inadequate in 2.8% of the cases. In conclusion, our study showed that FSGS was the most common primary GN encountered, while LN was the most common secondary GN. We encountered 14 cases of crescentic glomerulonephritis. Also, the prevalence of MPGN, MCD, IgA nephropathy and membranous GN was many folds higher in males when compared with the Western data. We believe that it is mandatory to maintain a Saudi Arabian Renal Biopsy Registry to understand better the pattern of glomerular disease in the Saudi population and to follow any change in trend.

Glomerulonephritis disease pattern at Saudi tertiary care center

“… 12 Likewise, most studies in the Kingdom have reported LN as the most common cause of secondary GN. 6 The 38.6% prevalence of LN in our entire cohort was much higher than that reported in other series. In the largest study from the Kingdom, reported in 2000, SLE was associated with 126 GN cases; 17.7% of the cohort comprised primary and LN cases.…”

“…Focal segmental glomerulosclerosis is typically reported as the most common primary GN; however, MCD, MGN, and MPGN have also been reported to have the highest prevalence, although longitudinal data from similar catchment areas are not available. 6 Registry data were published in 2000 from 4 hospitals in Riyadh, one in Jeddah, and one in the eastern province, which included 782 adult patients with GN. 3 Similar to our patients, FSGS was also the predominate pattern, observed in 21.3% of adult biopsies with primary GN.…”

“…A retrospective analysis of 296 biopsy samples acquired between 1989 to 2007 from adults in the Western region of Saudi Arabia was performed, 4 and data from single centers in Riyadh representing 120 biopsies performed from 1990 to 2001 5 and 348 biopsies performed from 2005 through 2009 were reported. 6 To supplement these reports with more recent data, a retrospective review was performed on 166 kidney biopsies performed from 2007 to 2016 at King Fahad Medical City (KFMC), Riyadh, which is a referral center for patients representing all regions of the Kingdom of Saudi Arabia (KSA).…”

Association between PLA2R1 rs4664308 and susceptibility to idiopathic membranous nephropathy

“…[ 5 – 7 ] In contrast, its prevalence in Bangladesh and Saudi Arabia is low, at 7.37% and 9.90%, respectively. [ 8 , 9 ] IMN has been also reported to have a greater prevalence in Caucasians than in Asians. [ 10 ] IMN accounts for 20% to 30% of nephrotic syndrome cases in Caucasian adults, and this proportion is also increasing in Asian adults.…”

Management of Membranous Nephropathy in Asia

“…A single-center study performed by Pan et al [4] found that the prevalence of MN has kept increasing during the past decades from 6.48% in 1997-1999 to 22.79% in 2009-2011. However, MN is less common in Bangladesh and Saudi Arabia, accounting for 7.37 and 9.90% of PGN patients, respectively [5,6]. In addition, idiopathic MN (IMN) accounted for 12.3 and 12.0% of all renal biopsies in Korea and Oman, respectively [7,8].…”