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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2009  |  Volume : 20  |  Issue : 2  |  Page : 295-299
Patterns of primary glomerular diseases among adults in the western region of Saudi Arabia


Pathology Department, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia

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   Abstract 

The frequency of primary glomerular diseases is variable from one part of the world to the other. Data published from Saudi Arabia has shown wide range of variation in the different regions of the country. This study reports the frequency of primary glomerulonephritis (GN) in adults in the Western region of Saudi Arabia. The study is based on retrospective evalua­tion of archived renal biopsy in the period of 18 years (1989-2007). The 296 selected cases of primary GN were studied by light, immunofluorescence, and electron microscopy. The patients age range between 17-76 years. Results show that the most frequent primary GN is membranous GN (MGN) constituting 25.7%, followed by focal segmental glomerulosclerosis (FSGSC) at 21.3%. Less frequent GN are immunoglobulins A nephropathy (IgAN) representing 17.6%, membrano­proliferative GN (MPGN) 11.5%, immunoglobulin M nephropathy (IgMN) 7.8%, minimal change disease (MCD) 5.4% and mesangioprolifertive GN (MesPGN) 4.7%. Other GN which are rarely encountered in this study are fibrillary GN (FGN) (3%), postinfectious GN (PIGN) (2%), Alport syndrome (AS) (0.7%) and membranoproliferative GN type II or dense deposit disease (DDD) (0.3%). In conclusion this study demonstrates that MGN is the most common primary GN encountered in the studied cases, the second more frequent is FSGSC. This result is in contrast to previous reports from Saudi Arabia where MGN is reported with low frequency and FSGSC is reported the most common primary GN.

Keywords: Primary Glomerular Disease, Adult, Saudi Arabia

How to cite this article:
Jalalah SM. Patterns of primary glomerular diseases among adults in the western region of Saudi Arabia. Saudi J Kidney Dis Transpl 2009;20:295-9

How to cite this URL:
Jalalah SM. Patterns of primary glomerular diseases among adults in the western region of Saudi Arabia. Saudi J Kidney Dis Transpl [serial online] 2009 [cited 2019 Nov 22];20:295-9. Available from: http://www.sjkdt.org/text.asp?2009/20/2/295/45586

   Introduction Top


The pattern of glomerulonephritis (GN) in Saudi Arabia and in the Arab world is not well documented. Several studies have emerged to report the frequency of glomerulonephritis, how­ever there is no evidence for national epide­miologic studies in the Arab world. [1],[2],[3] Wide range of variation in the frequency of primary glomerular diseases has been shown in the different regions of Saudi Arabia; [4] which might be explained by the difference in the geographic distribution, environmental factors, socioeconomic status, and genetic factors. The current study reports the frequency of primary glomerular diseases in the Western region of Saudi Arabia.


   Patients and Methods Top


All percutaneous renal biopsy specimens sub­mitted to our hospital and research centre in the period between 1989 and 2007 were re­viewed retrospectively, patients or biopsies were referred from different hospitals in the region. The total of 568 adult kidney biopsies were done during this period. Out of these, some cases were excluded due to insufficient tissue, transplant cases, secondary glomerulo­nephritis, end stage kidney disease, normal glomeruli, tubulointerstitial diseases, and vas­culitis [Table 1]. The 296 cases were finally included for analysis in this study the primary diagnosis of glomerular diseases. The group of primary glomerular diseases is analysed and categorized; data is illustrated as frequency and percentages.

All renal biopsies were examined by light microscopy, immunofluoresence and electron microscopy. Renal cortical tissue was divided between the three studies. For light micros­copy, tissue submitted is fixed in buffered for­malin and routinely processed into paraffin blocks, sections are stained with haematoxylin and eosin (H&E), periodic acid Schiff (PAS), silver methenamine and Masson trichrome. Immunofluoresence was performed on frozen sections labelled with the direct fluorescein isothiocyanate (FITC)-conjugated antibodies against IgG, IgA, IgM, C3, C4, C1q and fibri­nogen. For electron microscopy the tissue was fixed in Trump's fixative then routinely pro­cessed into resin embedded blocks; ultrathin sections were stained with uranyl acetate and lead citrate and examined with transmission electron microscope Philips CM100.


   Results Top


The renal biopsies with primary glomerular diseases diagnosed during the last 18 years are retrospectively analysed. There were 296 na­tive renal biopsies identified with primary glomerulonephritis which is the largest group among other renal diseases constituting 52.1%[Table 1]. The patients were adults; age ranging from 17 to 76 years. The frequency of diffe­rent types of primary glomerulonephritis is illustrated in [Table 2]. The most frequent glo­merulonephritis was membranous GN repre­senting 25.7% of the cases, followed by focal segmental glomerulosclerosis. IgA Nephropathy and MPGN ranked next but their frequency was not close to MGN or FSGSC. Lower fre­quencies were observed for minimal change disease, mesangioprloifrtaive disorder and IgMN; FGN, and PIGN were less frequent. A very low frequency was observed for Alport syndrome and dense deposit disease. The female to male ratio was 1:1.2; the gender distribution for each primary GN separately is illustrated in [Table 3].


   Discussion Top


This study examines the frequency of prima­ry glomerulonephritis (GN) in adult population in a single centre study in the Western region of Saudi Arabia. The results demonstrated that membranous glomerulonephritis is the most common primary GN in adults constituting 25.7% which is closely followed by focal seg­mental glomerulosclerosis at 21.3%.

The high frequency of MGN reported in this study has not been reported in any other series from Saudi Arabia. [4],[5],[6],[7],[8],[9] However similar results with high MGN frequency are demonstrated in a study from Iran where MGN constituted 23.6% and it was the most common primary GN in their adult study population as well. [10]

The frequency of FSGSC in the present study is close to that reported in a study from Saudi Arabia by Huraib et al. [8] Other studies reported FSGSC as the most common primary GN in adults mostly in reports from Riyadh the central region of Saudi Arabia [5],[6],[11] and in one study from Dhahran the Eastern part of Saudi Arabia. [9] FSGSC seems to have variable high frequencies in different parts of Saudi Arabia; and the lowest is reported in Asir the South Western region. [7]

MPGN in the current study represents only 11.5% of all primary glomerular diseases, similar low frequency for MPGN are reported in Riyadh, [12] and much lower frequencies for MPGN have also been reported in Saudi popu­lation at 2-3%. [5],[6] Whereas the study from Asir in the South Western region reported MPGN as the most common primary GN in adults representing 25.9%. [7]

IgA nephropathy reported in this study cons­tituted 17.6%, third most common GN. Simi­larly, most studies from different regions of Saudi Arabia reported lower frequencies for IgAN ranging from 6-17%. [5],[6],[7],[8],[9],[12] These results indicates that IgAN is not a common primary GN in Saudi Arabia, and apparently it is not common in the neighbouring countries such as Bahrain [13] and Iran. [10] This is in contrast to the higher frequencies of IgAN in studies from Europe, [14],[15] North America, [16] South America [17] and Far East. [18],[19]

IgM nephropathy has not been reported in adults in the reports from Saudi Arabia, this study reports the frequency of IgMN around 7.8% even higher than MCD 5.4%. It is obvious there are wide variations in the occurrence of primary GN in the different re­gions of Saudi Arabia which is also different from other parts of the world. Geographic and ethnic factors may be responsible for these va­riations. Studies show that the frequency of primary GN is different among different ethnic groups. It has been demonstrated that FSGSC is more prevalent in blacks; [20],[21] and MGN is more common in white patients. [21] Unfortu­nately studies arising from Saudi Arabia (in­cluding this study) do not make the distinction of disease occurrence in relation to different ethnic groups as ethnicity is not documented as part of the patient data.

The Western region of Saudi Arabia, espe­cially the regions of the holy cities, Makkah and Madinah, is known to have a heteroge­neous population with mixed ethnicity due to the settled pilgrims. Since genetics plays a role in the disease occurrence, ethnicity should be addressed in clinical reports and demographic data collection.

In conclusion the spectrum of primary GN is different in the different regions of Saudi Ara­bia. The current study is the only study from the Western region of Saudi Arabia that re­ports high frequency of MGN among primary GN in adults. For better understating of the aetiology and the factors influencing the di­sease occurrence, the difference in the pattern in the different regions of Saudi Arabia should be acknowledged and correlation with ethnic groups should be documented. This can be achieved efficiently by conducting a larger population study through the national registry for renal diseases.

 
   References Top

1.Barsoum RS, Francis MR. Spectrum of Glo­merulonephritis in Egypt. Saudi J Kidney Dis Transpl 2000;11:421-9.  Back to cited text no. 1  [PUBMED]  Medknow Journal
2.Al Arrayed A, Shariff S, Al Maamari M. Kidney Disease in Bahrain: A biopsy based epidemiologic study. Saudi J Kidney Dis Transplant 2007;18:638-42.  Back to cited text no. 2    
3.Said R, Hamzeh Y, Tarawneh M. The Spectrum of glomerulopathy in Jordan. Saudi J Kidney Dis Transpl 2000;11:430-3.  Back to cited text no. 3  [PUBMED]  Medknow Journal
4.Mitwalli AH. Glomerulonephritis in Saudi Arabia: A review. Saudi J Kidney Dis Transpl 2000;11:567-76.  Back to cited text no. 4  [PUBMED]  Medknow Journal
5.Al Wakeel JS, Mitwalli A, Tarif N, et al. Spectrum and outcome of primary glomerulo­nephritis. Saudi J Kidney Dis Transpl 2004; 15:440-6.  Back to cited text no. 5    
6.Mousa D, Al-Hawas F, Al-Sulaiman M, Al­Khader 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.  Back to cited text no. 6  [PUBMED]  Medknow Journal
7.Al-Homrany MA. Pattern of renal diseases among adults in Saudi Arabia: A clinico­pathologic study. Ethn Dis 1999;9:463-7.  Back to cited text no. 7  [PUBMED]  
8.Huraib S, Al Khader A, Shaheen FA, et al. The spectrum of glomerulonephritis in Saudi Arabia: The Results of the Saudi Registry. Saudi J Kidney Dis Transpl 2000;11:434-41  Back to cited text no. 8  [PUBMED]  Medknow Journal
9.Alkhunaizi A. Pattern of renal pathology among renal biopsy specimens in Eastern Saudi Arabia. Saudi Med J 2007;28:1676-81.  Back to cited text no. 9    
10.Naini AE, Harandi AA, Ossareh S, Ghods A, Bastani B. Prevalence and clinical findings of biopsy-proven glomerulonephritidis in Iran. Saudi J Kidney Dis Transpl 2007;18:556-64  Back to cited text no. 10  [PUBMED]  Medknow Journal
11.Mitwalli AH, Al Wakeel JS, Al Mohaya SS, et al. Pattern of glomerular disease in Saudi Arabia. Am J Kidney Dis 1996;27:797-802.  Back to cited text no. 11  [PUBMED]  [FULLTEXT]
12.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.  Back to cited text no. 12  [PUBMED]  Medknow Journal
13.Al Arrayed A, George SM, Malik AK, et al. The spectrum of glomerular diseases in the Kingdom of Bahrain: An epidemiological study based on renal biopsy interpretation. Transplant Proc 2004;36:1792-5.  Back to cited text no. 13    
14.Simon P, Ramee MP, Boulahrouz R, et al. Epidemiologic data of primary glomerular diseases in western France. Kidney Int 2004; 66:905-8.  Back to cited text no. 14  [PUBMED]  [FULLTEXT]
15.Simon P, Ramee MP, Autuly V, et al. Epidemiology of primary glomerulopathies in a French region. Variations as a function of age in patients. Nephrologie 1995;16:191-201.  Back to cited text no. 15    
16.Dragovic D, Rosenstock JL, Wahl SJ, et al. Increasing incidence of focal segmental glome­rulosclerosis and an examination of demo­graphic patterns. Clin Nephrol 2005;63:1-7.  Back to cited text no. 16  [PUBMED]  
17.Bahiense-Oliveira M, Saldanha LB, Mota EL, et al. Primary glomerular diseases in Brazil (1979-1999): Is the frequency of focal and segmental glomerulosclerosis increasing? Clin Nephrol 2004;61:90-7.  Back to cited text no. 17  [PUBMED]  
18.Kanjanabuch T, Kittikovit W, Lewsuwan S, et al. Etiologies of glomerular diseases in Thailand: A renal biopsy study of 506 cases. J Med Assoc Thai 2005;88:S305-11.  Back to cited text no. 18  [PUBMED]  
19.Chen H, Tang Z, Zeng C, et al. Pathological demography of native patients in a nephrology center in China. Chin Med J (Engl) 2003; 116:1377-81.  Back to cited text no. 19  [PUBMED]  [FULLTEXT]
20.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 1995­1997. Am J Kidney Dis 1997;30:621-31.  Back to cited text no. 20  [PUBMED]  [FULLTEXT]
21.Korbet SM, Genchi RM, Borok RZ, Schwartz MM. The racial prevalence of glomerular lesions in nephrotic adults. Am J Kidney Dis 1996;27:647-51.  Back to cited text no. 21  [PUBMED]  [FULLTEXT]

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Correspondence Address:
Sawsan M Jalalah
Pathology Department, College of Medicine, King Abdulaziz University, P.O. Box 512, Jeddah, 21421
Saudi Arabia
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PMID: 19237826

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    Tables

  [Table 1], [Table 2], [Table 3]

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