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Saudi Journal of Kidney Diseases and Transplantation
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ARTICLE Table of Contents   
Year : 2000  |  Volume : 11  |  Issue : 3  |  Page : 430-433
The Spectrum of Glomerulopathy in Jordan


1 Department of Medicine, Jordan Hospital, Amman, Jordan
2 Department of Medicine, Jordan University Hospital, Amman, Jordan
3 Department of Pathology, Jordan University Hospital, Amman, Jordan

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   Abstract 

In this study, we reviewed the records and the histological findings of a total of 350 adequate native kidney biopsies at both the Jordan University Hospital (260 biopsies in the period 1986-1989) and the Jordan Hospital (90 biopsies in the period 1997-1999). There were 187 males (53.4%) and 163 females (46.6%). Their ages ranged between 12-77 years. The nephrotic syndrome was the presenting feature in 194 (55.4%) patients, acute renal failure in 55 (15.7%), hematuria and/or non-nephrotic proteinuria in 45 (12.9%), chronic renal failure in 32 (9.1%) and hematuria alone 24 (6.9%). In the patients with the nephrotic syndrome, 140 (72.2%) had primary nephrotic syndrome. In this group membranoproliferative glomerulonephritis (MPGN) was the most common pathology and was detected in 49 patients (35%) followed by focal segmental glomerulosclerosis (FSGS) in 38 (27.1%). Amyloidosis and systemic lupus erythematosus were the commonest findings among the 54 patients with secondary nephrotic syndrome (40.7% and 38.8% respectively). Rapidly progressive glomerulonephritis was seen in 34.5% of those patients presenting with acute renal failure, while FSGS was seen in 25% of those with chronic renal failure. Finally IgA nephropathy was the major finding among both the 45 patients with hematuria-proteinuria and the 24 patients with isolated hematuria (26.2% and 66.6% respectively).

Keywords: Glomerulonephritis, Nephrotic syndrome, Acute renal failure, and chronic renal failure, Jordan.

How to cite this article:
Said R, Hamzeh Y, Tarawneh M. The Spectrum of Glomerulopathy in Jordan. Saudi J Kidney Dis Transpl 2000;11:430-3

How to cite this URL:
Said R, Hamzeh Y, Tarawneh M. The Spectrum of Glomerulopathy in Jordan. Saudi J Kidney Dis Transpl [serial online] 2000 [cited 2020 Jun 5];11:430-3. Available from: http://www.sjkdt.org/text.asp?2000/11/3/430/36665

   Introduction Top


Jordan is an Arab country in the northwestern corner of the Arab peninsula. It has an area of 89,206 sq. kilometers and a population of 4.5 million, with nearly 1.3 million residing in the capital Amman. The major health care providers are the Ministry of Health, the Royal Medical Services, the University Hospital, and recently the private sector. The latter is currently playing a major role in the health care management.

In this report, we will analyze the pattern of glomerular diseases that was seen at both the Jordan University Hospital (500 beds) and the Jordan Hospital, a private hospital with a capacity of 220 beds. In addition, an attempt will be made to compare our data with what has been published previously from Jordan, [1] the neighboring Arab countries [2],[3] and international literature. [4]


   Materials and Methods Top


A total of 350 adequate kidney biopsies were reviewed at both the Jordan University Hospital (260 biopsies in the period between 1986-1989), and the Jordan Hospital (90 biopsies in the period between 1997-1999. For a biopsy to be considered adequate at least six glomeruli were required to be present for evaluation. Biopsies were examined with only light and immuno­fluorescence microscopy, since electron microscopy was not available for the study.


   Results Top


There were 187 males (53.4%) and 163 females (46.6%), and none of them was a transplant patient. Their ages ranged between 12-77 years; 126 patients (36%) between 12-20 years, 158 (45.1%) between 20-40 years, 50 (14.3%) between 40-60 years and 16 (4.6%) above 60 years.

The nephrotic syndrome was the presenting feature in 194 (55.4%) patients, acute renal failure in 55 (15.7%), hematuria and/or non-nephrotic proteinuria in 45 (12.9%), chronic renal failure in 32 (9.1%) and hematuria alone 24 (6.9%).

In the patients with the nephrotic syndrome, 140 (72.2%) had primary nephrotic syndrome (PNS) while 54 patients (27.8%) had secon­dary nephrotic syndrome (SNS). Among the patients with PNS, membranoproliferative glomerulonephritis (MPGN) was the most common pathology, being detected in 49 patients (35%) followed by focal segmental glomerulosclerosis (FSGS) in 38 (27.1%), [Table - 1]. The renal pathological findings among the SNS patients included amyloi­dosis of various etiologies that were seen in 22 patients (40.7%) followed by systemic lupus nephritis (SLE) in 21 patients (38.8%), [Table - 2].

There were 55 patients (15.7%) who presented with acute renal failure (ARF), [Table - 3]. Rapidly progressive glomerulo­nephritis (RPGN) was the leading cause of ARF and was found in 19 (34.5%) patients. Immune-complex mediated RPGN variety (granular pattern on immuno-fluorescence) was seen in 15 cases; SLE related in four, acute post-streptococcal glomerulonephritis in three, idiopathic type in five, familial  Mediterranean fever More Details (FMF) in two and Henoch-Schonlin purpura (HSP) in one.

Anti-neutrophilic cytoplasmic antigen (ANCA) related RPGN was seen in three patients; two had Wegner's granulomatosis, one had polyarteritis nodosa (PAN), and one had anti-glomerular basement membrane antibodies (linear pattern on immunofluo­rescence).

In the 45 patients (12.5%) who had hema­turia/proteinuria as the clinical presentation, the histological findings were distributed as follows. MPGN was found in 10 (22.2%) patients, primary IgA nephropathy in nine (20%), primary mesangioproliferative glomerulonephritis (MsPGN) in eight (17.7%), SLE in seven (15.5%), FSGS in six (13,3%), secondary IgA in three (6.2%) and hereditary nephritis of the Alport's variety in two (4.4%).

The patients who presented with isolated hematuria had either macroscopic (10 cases) or microscopic (14 cases) hematuria. Primary IgA nephropathy was diagnosed in 13 (54%) patients and secondary IgA nephropathy related to FMF in three (12.5%). The rest included seven (29.2%) cases of MsPGN and one case (4.2%) of Alport's syndrome.

Of the 32 patients who presented with chronic renal failure, FSGS and amyloi­dosis were the leading findings. The rest of causes were of multiple etiologies, [Table - 4].

Finally, we looked also into the findings among the elderly group (age between 60­77 years). There were 16 patients in this group of whom 11 patients (68.8%) had the nephrotic syndrome. Seven of the nephrotic patients had SNS: four patients with amyloidosis, two with light chain myeloma, one with diabetes mellitus. Four of the elderly nephrotic patients had PNS: three due to membranous nephropathy and one had FSGS. Other findings included ARF in two cases (post infectious glomerulo­nephritis and acute tubular necrosis), chronic renal failure in two (MPGN and chronic interstitial nephritis) and MsPGN in one case of hematuria and proteinuria.


   Discussion Top


In this retrospective study which covers the two major referral hospitals in Jordan, only adolescents and adult patients were included. Children less than 12 years were excluded. Accordingly, we had low incidence of MCD (13.6%) among our patients, which is different from what has been published previously. [1],[5],[6]

As far as the indication for kidney biopsies, our findings are in agreement with what has been published previously, indicating that nephrotic syndrome is the major indication for kidney biopsy. [1],[5]

The major histological finding among the patients with PNS was MPGN (35%), followed by FSGS (27%). These findings are comparable with a previous publication from Jordan [1] but different from what has been published from Saudi Arabia. Akhtar [7] found FSGS in 30.4% of 148 patients, while Huraib [8] found it in 21.3% of 587 patients and Hass et al [4] found it in 35% of the patients in their series.

The interesting finding in our study was the high incidence of amyloidosis among the patients with secondary nephrotic syndrome at a percentage of 40.7%. This is a very high prevalence in contrast to what has been published from Saudi Arabia, where both Qunibi [9] and Akhtar [7] reported a prevalence rate of amyloidosis of 13.8% and 5.2% respectively. This high prevalence of amyloidosis in our study is attributed to the high prevalence of FMF in Jordan. In fact 45.5% of the amyloid cases were due to FMF.

The prevalence of 9.5% of IgA nephropathy in our study is perhaps marginally higher than the 6.5% IgA nephropathy among the 587 patients with primary GN reported by Huraib et al [8] from Saudi Arabia of, and the 3% prevalence in Abdurrahman's 300 cases (mostly children) from the same country. [10]

The prevalence of SLE was 38.8%. This is probably not much different from the report of 44.8% prevalence reported by Qunibi et al [9] and the 46.7% by Akhtar et al [7] from Saudi Arabia.

In the acute renal failure group, our findings are in agreement to what has been published previously. [11]

Finally, the findings among the elderly group (age between 6-77 years) were interesting and not different from a previous publication. [12]

In conclusion, our data show that MPGN and IgA nephropathy are the commonest types of primary glomerulonephritis in Jordan. At least amyloidosis (mostly FMF) came out as a distinctly common entity of the secondary nephropathies in Jordan, unlike many other Arab countries.

 
   References Top

1.Ghnaimat M, Akash N, El-Lozi M. Kidney biopsy in Jordan. Saudi J Kidney Dis Transplant 1999;10(2):152-6.  Back to cited text no. 1    
2.Mitwalli AH, Al-Wakeel JS, Al-Mohaya SS, et al. Pattern of glomerular disease in Saudi Arabia. Am J Kidney Dis 1996;27(6):797-802.  Back to cited text no. 2    
3.Essamie MA, Soliman A, Fayad TM, et al. Serious renal disease in Egypt. Int J Artif Organs 1995;18(5):254-60.  Back to cited text no. 3    
4.Haas M, Meehan SM, Karrison TG, Spargo BH. Changing etiologies of unexplained adult nephrotic syndrome: a comparison of renal biopsy findings from 1976-1979 and 1995-1997. Am J Kidney Dis 1997;30:621-31.  Back to cited text no. 4  [PUBMED]  
5.Al Menawy L, Amousi J, Ramprasad KS, Shaheen FM. Percutaneous renal biopsy and its findings in children and adolescents in Saudi Arabia: a single center experience. Saudi J Kidney Dis Transplant 1997;8(3):289-93.  Back to cited text no. 5    
6.Nephritic syndrome in children: prediction of histopathology from clinical and laboratory characteristics at time of diagnosis. A report of the International Study of Kidney Disease in Children. Kidney Int 1978;159-65.  Back to cited text no. 6    
7.Akhtar M, Qunibi W, Taher S, et al. Spectrum of renal diseases in Saudi Arabia. Ann Saudi Med 1990;10(1):37-44.  Back to cited text no. 7    
8.Huraib SO. The pattern of glomerulo-nephritis in Saudi Arabia: for the glomerulonephritis registry group. Abstract book 28. The 5 th congress of the Arab Nephrology and Transplantation. Beirut­Lebanon 1997.  Back to cited text no. 8    
9.Qunibi W, Al Sibai MB, Taher S, Akhtar M. Renal diseases in Saudi Arabia. A study of 147 renal biopsies. The King Faisal Specialist Hospital Medical Journal 1984;4(4):317-23.  Back to cited text no. 9    
10.Abdurrahman MB. Percutaneous renal biopsy in a developing country: experience with 300 cases. Ann Trop Pediatr 1984;4:25-30.  Back to cited text no. 10    
11.Grcevska L, Polenakovic M. Crescentic glomerulonephritis as renal cause of acute renal failure. Ren Fail 1995;17(5)595-604.  Back to cited text no. 11    
12.Donadio JV Jr. Treatment of glomerulo-nephritis in the elderly. Am J Kidney Dis 1990;16(4):307­11.  Back to cited text no. 12    

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Correspondence Address:
Riyad Said
Department of Medicine, Jordan Hospital, P.O. Box 13132, Amman
Jordan
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PMID: 18209335

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  [Table - 1], [Table - 2], [Table - 3], [Table - 4]



 

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