Trends of primary glomerular disease in Turkey: TSN-GOLD registry report

Abstract

Background Although several renal biopsy registry reports have been published worldwide, there are no data on primary glomerular disease trends in Turkey. Methods Three thousand eight-hundred fifty-eight native kidney biopsy records were assessed in the Turkish Society of Nephrology Primary Glomerulopathy Working Group (TSN-GOLD) Registry. Secondary disease and transplant biopsies were not recorded in the registry. These records were divided into four periods, before 2009, 2009 to 2013, 2013-2017, and 2017-current. Results A total of 3858 patients (43.6% female, 6.8% elderly) were examined. Nephrotic syndrome was the most common biopsy indication in all periods (58.6%, 53%, 44.1%, 51.6%, respectively). In the whole cohort, IgA nephropathy (IgAN) (25.7%) was the most common PGN with male predominance (62.7%), and IgAN frequency steadily increased through the periods (× 2 = 198, p < 0.001). MGN was the most common nephropathy in the elderly (> 65 years), and there was no trend in this age group. An increasing trend was seen in the frequency of overweight patients (× 2 = 37, p < 0.0001). Although the biopsy rate performed with interventional radiology gradually increased, the mean glomeruli count in the samples did not change over the periods. Conclusions In Turkey, IgAN is the most common primary glomerulonephritis, and the frequency of this is increasing.

Clinicopathological Evaluation of Elderly Biopsies in Turkish Society

“…This increase has been attributed to increased awareness of FSGS and an increase in the incidence of FSGS in the elderly secondary to diseases such as HT and agerelated nephropathy 30 . In studies conducted abroad, while MGN stands out as the most frequently detected PGN in Spain 37 , Czech Republic 11,24 , in our study, MGN (39.4%) was found to be the most common and FSGS (12.1%) was the second most common glomerular pathology, both among PGNs and among all patients who underwent biopsy. In terms of the frequency of PGN, the results of our study are similar to those reported by recent large-scale studies conducted in our country 11,26 .…”

“…Although biopsy indications vary on a national or center basis in the literature, it has been reported in many biopsy series that the most common indication in the elderly is nephrotic proteinuria 11,23,24,26,27 . In our study, nephrotic proteinuria (56.1%) was found to be the most common biopsy indication in the elderly.…”

“…In our study, nephrotic proteinuria (56.1%) was found to be the most common biopsy indication in the elderly. Studies conducted in our country have reported that the rate of kidney biopsy performed with the indication of nephrotic proteinuria in the elderly is between 41.38% and 60% 11,[21][22][23][24]26,28 . The fact that nephrotic proteinuria is the most common biopsy indication may be due to the fact that the elderly see the symptoms as a part of the natural process of aging and apply to the hospital late.…”

“…In addition, in the period covering 2017 and before, crescentic GN (23%) was the second most common type of GN and FSGS (15.2%) was the third most common type of GN. It has been stated that as of 2017, FSGS has become the second most common GN and the frequency of FSGS in the elderly is gradually increasing 11 . Studies have shown that the incidence of FSGS in the elderly is increasing worldwide 23,36 .…”

“…In Turkey, the elderly population, which was 7.18 million in 2018, increased by 21.4% in the last five years and reached 8.7 million in 2023, and this figure is expected to increase to approximately 16 million in 2040 9 . In parallel with the increasing elderly population, the number of renal biopsies in the elderly is gradually increasing 10,11 . In our country, studies evaluating the results of renal biopsy in the elderly are limited in number.…”