| Abstract|| |
Many renal lesions may result in chronic kidney disease if not detected early or treated properly. Glomerulonephritis is considered one of the leading causes of end-stage renal disease. The prevalence of different renal lesions were identified by inconsistent studies. The causes of inconsistencies include lack of unified methods in diagnosing and processing renal biopsies by different pathologists, patients selection's bias for renal biopsy, and the variable policies and protocols adopted by different nephrologists. Establishment of renal biopsy registry may help to surmount these differences. In addition, combined data obtained from renal biopsy renal and replacement therapy registries can help study the long-term outcome of patients with renal diseases.
Keywords: Renal biopsy, Registry
|How to cite this article:|
Al-Homrany M. Need for Renal Biopsy Registry in Saudi Arabia. Saudi J Kidney Dis Transpl 2008;19:346-9
| Introduction|| |
The prevalence of renal diseases is high, although true incidence of end stage renal disease (ESRD) is usually underestimated in many countries including Saudi Arabia. 
Most of the cases approaching ESRD are labeled either as unknown cause or hypertensive nephrosclerosis, [Table - 1]. Many such cases are most likely due to chronic glomerulonephritis (GN) that is not diagnosed and treated early. Therefore, GN may contribute to high percentage of the causes of chronic kidney diseases (CKD), and can be diagnosed properly by performing renal biopsies, which assist therapy and predict prognosis.
Several retrospective studies about the pattern of GN in Saudi Arabia concluded that focal segmental glomerulosclerosis (FSGS) was the predominant lesion (15-36.6%). ,, However, others suggested mesangiocapillary GN as the most commonly found pathological lesion (26.4%-38%). , IgA nephropathy, which is a very common disease worldwide, was reported in these studies with variable prevalence (6.5-19%). ,,,,,,,, The prevalence of membranous lesion was reported to be from 2.5%-10.6%. ,,,,,,,, These variations of prevalence of GN lesions were not only observed among different centers but also within the same center reporting different results, ,, [Table - 2].
Most of the studies about prevalence of GN in Saudi Arabia were retrospective, hospital based and biased due to reporting from referral centers not community hospitals. Most renal biopsies in these studies lacked immunoflourescence and electron microscopic examination, reported by different pathologists, and did not have uniform indications of kidney biopsies among the different centers.
A better approach should prospective studies of prevalence in the form of a national renal biopsy registry (RBR) for results of renal biopsies. Such system may contribute to better understanding of the types of renal disease in Saudi Arabia. Pathologists should formulate a standard protocol or unified guidelines for the study of the renal biopsies. Furthermore, nephrologists need to agree on the basis of the indications of kidney biopsy to avoid biased selection of cases.
| Expected advantages of RBR|| |
Establishing RBR will be advantageous in several aspects:
- To describe the epidemiology of medical renal diseases: incidence, prevalence and trends in epidemiology.
- To identify high risk patients, prognostic factors and various complications.
- To link with other registries to compare the frequency of some renal diseases.
- To serve as a source for clinical interventions
- To serve as a source for identifying patients with rare renal diseases for clinical investigations.
- To serve as a source for single- and multicenter investigations research projects.
- To help performing genetic and other basic studies.
- To help studying the natural history of various glomerular diseases.
- To help developing protocols for preventive medicine.
| The suggested Structure of RBR|| |
To develop a well constructed structure for a registry, the supervising team should involve members from different health sectors and different regions of the kingdom. Both Nephrologists and Pathologists need to be involved. The database is owned by the involved institutes (Nephrologists and Pathologists). Each institute involved appoints one member to follow the tasks in that institute. The registry need to have a chairman with an executive power and has the responsibility for all secretarial work, coordination with representative members, moderation of the team meetings, data management, and preparation of annual reports. Duties of the members include meeting periodically, discussing developments, coordinating data collection, solving difficulties, approving annual reports, and deciding on utilization of the registry data.
| Method of data collection|| |
One of the important features of developing good quality clinical epidemiological research requires adequate and flexible database related to specific diseases.  Different registries have develo5ped different methods of data collection. ,,, Both paper and electronic based collection of database have advantages and disadvantages. Paper-based data collection can be adopted in the initial stage and with time this can be transferred to electronic data collection depending on the available resources. Standardized paper forms, which is a an easy, low cost, and secure method of data collection, can be filled out and faxed to the head-quarter.  Online data collection is a faster way with which each representative of health institute is provided with a password, and data can be uploaded to a designated website using a special software.
Both clinical and pathological data are important to establish good reference to causes, presentation, and prognosis of disease. Therefore, various clinical and laboratory parameters should be recorded during biopsy procedures such as patient's age, gender, blood pressure, renal function, degree of proteinuria, and serologic investigations. Pathologists reporting renal biopsies from different centers should standardize of the pathological reports diagnosing different types of renal diseases and utilize all available methods for processing renal tissues such as immunoflourescence stains and electron microscopy.
Finally, combined data of RBR and data collected by Saudi center for organ transplantation (SCOT) on ESRD patients will help health providers plan better for the health services rendered to kidney patients and provide appropriate management in order to prevent ESRD in Saudi Arabia.
| References|| |
|1.||Al-Homrany M, Abolfotoh M. Incidence of treated end-stage renal diseases in Asir region, Southern Saudi Arabia. Saudi J Kidney Dis Transpl 1998;9(4):425-9. |
|2.||Saudi Center for Organ Transplantation 2003. Annual Report. |
|3.||Qunibi W, Al-Sibai MB, Taher S, Akhtar M. Renal disease in Saudi Arabia: A study of 147 renal biopsies. King Faisal Specialist Hospital Journal 1984;4:317-23. |
|4.||Akhtar M, Qunibi W, Taher S, et al. Spectrum of renal disease in Saudi Arabia. Ann Saudi Med 1990;10:37-44. |
|5.||Mitwalli A, Al Wakeel J, Al Mohaya S, et al. Pattern of glomerular disease in Saudi Arabia. Am J Kidney Dis 1996;27(6):797-802. |
|6.||Alhomrany M. Pattern of renal diseases among adults in Saudi Arabia: A clinicopathological study. Ethn Dis 1999;9(3):463-7. |
|7.||Huraib S, Abu-Aisha H, Mitwalli A, Mahmood K, Memon N, Sulimani F. The spectrum of renal disease found by kidney biopsies at King Khalid University Hospital. Saudi Kidney Dis Transplant Bull 1990;1: 15-9. |
|8.||Al Wakeel J, Mitwalli A, Tarif N, et al. Spectrum and outcome of primary glomerulonephritis. Saudi J Kidney Dis Transpl 2004;15(4):440-6. |
|9.||Mitwalli A, Al Wakeel J, Abu-Aisha H, et al. Prevalence of glomerular diseases: King Khalid university hospital, Saudi Arabia. Saudi J Kidney Dis Transpl 2000;11:442-8. |
|10.||Huraib S, Al Khader A, Shaheen F, et al. The spectrum of glomerulonephritis in Saudi Arabia: The results of the Saudi Registry. Saudi J Kidney Dis Transpl 2000;11:434-41. |
|11.||Mousa D, Al Hawas F, Al Sulaiman M, Al Khader A. A prospective study of renal biopsies performed over one-year at the Riyadh Armed Forces Hospital. Saudi J Kidney Dis Transpl 2000;11:449-54. |
|12.||Gesualdo L, Di Palma A, Morrone L, et al. The Italian experience of the national registry of renal biopsies. Kidney Int 2004; 66(3):890-4. |
|13.||Heaf J. The Danish renal biopsy registery. Kidney Int 2004;66(3):895-7. |
|14.||Rivera F, Lopez-Gomez J, Perez-Garcia R; Spanish registry of glomerulonephritis. Frequency of renal pathology in Spain for 1994-1999. Nephrol Dial Transplant 2002; 17(9):1594-602. |
|15.||Davidson A. The United Kingdom Medical Research Council's Glomerulonephritis Registry. Contrib Nephrol 1985;48:24-35. |
Department of Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha
[Table - 1], [Table - 2]