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Saudi Journal of Kidney Diseases and Transplantation
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ORIGINAL ARTICLE Table of Contents   
Year : 2009  |  Volume : 20  |  Issue : 4  |  Page : 608-612
Childhood primary glomerular diseases in the western region of Saudi Arabia


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

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Date of Web Publication8-Jul-2009
 

   Abstract 

We report our institute experience on primary glomerular disease in children in the western region of Saudi Arabia over the last 18 years (1988 to 2006). A total of 169 cases were identified as primary glomerular diseases in children and adolescent with age range from first year of life till 18 years. Minimal change disease and focal segmental glomerulosclerosis were the com­monly encountered primary glomerular diseases (20.1%and 19.5% respectively), mesangioprolifera­tive glomerulonephritis IgM nephropathy (14.8%), IgA nephropathy (10.7%), postinfectious glome­rulonephritis (9.5%), membranous glomerulonephritis (7.1%), membranoproliferative glomerulone­phritis (5.9%) and mesangioproliferative glomerulonephritis with negative immunofluorescence (5.9%). The less frequently encountered primary glomerular diseases were congenital nephritic syn­drome Finnish type (2.4%), Alport syndrome (2.4%), dense deposit disease (1.2%), and mesangio­proliferative glomerulonephritis with IgG positive (0.6%). We concluded that minimal change di­sease and focal segmental glomerulosclerosis are the most common primary glomerular disorder en­countered in children in our series and with similar age distribution.

Keywords: Glomerular diseases, Primary, Children, Saudi Arabia

How to cite this article:
Jalalah SM, Jamal AA. Childhood primary glomerular diseases in the western region of Saudi Arabia. Saudi J Kidney Dis Transpl 2009;20:608-12

How to cite this URL:
Jalalah SM, Jamal AA. Childhood primary glomerular diseases in the western region of Saudi Arabia. Saudi J Kidney Dis Transpl [serial online] 2009 [cited 2019 Dec 9];20:608-12. Available from: http://www.sjkdt.org/text.asp?2009/20/4/608/53249

   Introduction Top


Glomerular diseases in the gulf region and in the Middle East are generally not well docu­mented; moreover fewer studies are focused on children. [1],[2],[3],[4]

Reports have emerged in the last two decades describing the pattern of glomerular diseases in Saudi Arabia, with some similarities and discre­pancies in their results. [5],[6],[7]

This study presents the experience of our ins­titute which provides care to centers in the wes­tern region of Saudi Arabia. We report the fre­quency of the primary glomerular diseases in children and adolescents in the western region to contribute for better understanding of the pathogenesis of glomerulonephritis in our region.


   Subjects and Methods Top


A total of 632 percutaneous renal biopsies in the period of 1988 to 2006, at our institute were reviewed retrospectively. Patients' demographic data, age and gender, were collected from the hospital charts. The histopathology, immuno­fluorescence and electron microscopy findings were evaluated.

Out of the 632 biopsies, a total of 242 cases were children and adolescent with age range from first year of life till 18 years old. Of these 242 renal biopsies only 169 cases were identi­fied as primary glomerular diseases, thereafter analyzed and classified in this study.

The remaining cases were not included in the analysis for the following reasons: end stage kidney disease (7 cases), the biopsy is insufficient (11 cases), and if the diagnosis is secondary glomerulopathy (51 cases), or non glomerular diseases (2 cases) and 2 transplant cases.

The renal cortical tissue obtained in these cases was processed for light microscopy, electron microscopy examination and frozen renal tissue sections are immunolabelled with FITC-conju­gated antibodies against (IgG, IgA, IgM, C3, C4, C1q, Kappa, Lambda and fibrinogen).


   Results Top


The patients identified with primary glomeru­lar diseases (n= 169); their age range was bet­ween 1-18 year; 94 were male and 71 female.

The frequency of primary glomerular diseases is demonstrated in [Table 1]. Minimal change di­sease (MCD) and focal segmental glomerulosclerosis (FSGSC) were the most frequently diagnosed conditions 34 cases and 33 cases res­pectively. Other diagnoses are mentioned in the [Table 1] and [Table 2]. The least frequent primary glo­merular diseases included congenital nephrotic syndrome Finnish type (FN) 4 cases and here­ditary nephritis Alport syndrome (AS) 4 cases.

Primary glomerular diseases affected males more frequently than females with a ratio of 1.3: 1 [Figure 1]. The male predominance was ob­served more in MCD, IgA nephropathy (IgAN), Membranous Glomerulonephritis (MGN), Mem­branoproliferative Glomerulonephritis Type I (MPGNI) and Post Infectious Glomeruloneph­ritis (PIGN), moreover Alport syndrome (AS) cases were all male. On the other hand female predominance was noted in cases of IgM Neph­ropathy (IgMN) and FSGSC. Equal male and female distribution was noted among FN and idiopathic mesangioproliferative GN (MesPGN).

The age at presentation of the primary glome­rular diseases varied from one entity to the other [Table 2]. MCD and FSGSC both frequently pre­sented early in age of 4-6 years. MGN affeced older age group (16-18 years). IgMN had two peaks of occurrence one at age 1-6 years and the second peak at age 16-18 years. Similarly PIGN had two peaks one at age 10-12 years and the second at age 16-18 years. IgAN showed an evenly distribution over all age groups with a minor peak at the age of 10-12 years.


   Discussion Top


Previous reports reveal the differences and si­milarities in the pattern of primary glomerular disease distribution from one part of the world to the other. Among the reports published in the literature from the Middle East and the Arab peninsula [1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12] some are concerned with the child­hood glomerular diseases. [1],[2],[3],[4],[5] ,[10],[11],[12]

The present study confirms that the primary glomerular diseases in children in the western region of Saudi Arabia are more frequent than secondary glomerulopathy representing a ratio of 3.3:1. Furthermore, the study illustrates that MCD and FSGSC are the most common diag­nosed entities occurring with almost equal fre­quency, 19.5% 20% respectively. This is similar to the report by Al-Rasheed et al, [2] from western region of Saudi Arabia. In contrary to this Sipiczki et al, in their study from Hungary, reported MCD as the most common primary glo­merular disease in children. [13]

On the other hand, FSGSC was found to be twice as common than MCD in the Iranian ex­perience. [4] This has also been documented in re­ports from Saudi Arabia. [5] ,[10]

The discrepancy of the reported frequencies of MCD and FSGSC from one series to the other could be related to renal biopsy policy, sample size or the geographic region and the nature of disease distribution. For centers where biopsy is performed only in children who are steroid re­sistant or steroid dependent this results in less frequent number of MCD patients undergoing renal biopsy. Therefore MCD is probably under represented in most of the series; resulting in the observed relative increase in the diagnosis of FSGSC among the submitted biopsies. A wider epidemiologic population studies will de­termine the actual glomerular disease frequency and its geographic distribution and hence will eliminate this bias in the analyzed submitted biopsies to the academic centers. Furthermore inclusion of children with nephrotic syndrome responding to therapy, thus suggesting MCD, will probably represent the actual frequency of MCD vs FSGSC.

IgMN was the third frequent diagnosis occur­ring in 14.8% of biopsies in our children. This is a higher number reported among our patients since IgMN is not as common and few series reported it as a distinct diagnosis in their series 14; and others have reported the frequency of MesPGN without distinction. [2] ,[5]

MPGN, on the other hand, has a low frequency, 7.1%, mainly type I. The frequency of MPGN among children with glomerular diseases in Saudi Arabia varies widely from as high as 30% in the study by Kari [5] to complete absence in another study. [2]

IgAN in our study represents 10.7% similar to reports from other parts of the world, however higher than the locally reported 3% by Al Ras­ heed. [2] ,[5] ,[16]

The frequency of MGN in our patients was 12% which is higher than reported by others. [13] ,[15]

Absence of thin basement membrane diseases (TBMD) in our study compared to others [13] ,[16] is probably the result of avoiding biopsy in mic­roscopic hematuria patients with no other ab­normalities.

Our study presents the frequency of primary glomerular diseases in children, the experience gained from the University hospital which is a referral and consultation center in the western region of Saudi Arabia.

In conclusion, the results demonstrated that the most frequently diagnosed primary glome­rular disorder among biopsied cases in our se­ries was MCD and FSGSC. Furthermore we suggest that the discrepancies in the reported frequencies of glomerular diseases seen in studies from different centers are affected by the biopsy policy in these centers and may not necessarily reflect the actual occurrence of the disease. Therefore these facts should be taken into consideration when comparison of data from different sources is performed. Finally, it is important to highlight the need for collabo­rative epidemiologic studies in our region to better understand and provide health care for the glomerular diseases especially in children where data is lacking.

 
   References Top

1.Abdurrahman MB, Elidrissy AT, Shipkey FH, Al-Rasheed SA, Al-Mugeiren MM. Clinicopa­thological features of childhood nephrotic syndrome in Saudi Arabia. Ann Trop Paediatr 1990;10:125-32.  Back to cited text no. 1    
2.Al-Rasheed SA, Al-Mugeiren MM, Al-Salloum AA, Al-Sohaibani MO. Childhood renal diseases in Saudi Arabia. A clincopathological study of 167 cases. Int Urol Nephrol 1996;28:607-13.  Back to cited text no. 2    
3.Barakat AJ, Atiyeh BA. Renal disease in Lebanese children and adolescents. Findings in 118 consecutive percutaneous renal biopsies. J Med Liban 1998;46:306-8.  Back to cited text no. 3    
4.Bodaghi E, Vazirian S, Abtahi M, et al. Glomerular diseases in children. "The Iranian experience". Pediatr Nephrol 1989;3:213-7. discussion 221.  Back to cited text no. 4    
5.Kari Ja. Changing trends of histopathology in childhood nephrotic syndrome in western Saudi Arabia. Saudi Med J 2002;23:317-21.  Back to cited text no. 5  [PUBMED]  
6.Mitwalli AH, Al Wakeel JS, Al Mohaya SS, et al. Pattern of glomerular disease in Saudi Arabia. Am J Kid Dis 1996;27:797-802.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]
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.Yahya TM, Pingle A, Boobes Y, Pingle S. Ana­lysis of 490 kidney biopsies: data from the United Arab Emirates Renal Diseases Registry. J Nephrol 1998;11:148-50.  Back to cited text no. 8  [PUBMED]  
9.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. 9    
10.Mattoo TK, Mahmood MA, Al-Harbi MS. Nephrotic syndrome in Saudi Children clinico­pathological study of 150 cases. Pediatr Nephrol 1990;4:517-9.  Back to cited text no. 10  [PUBMED]  
11.Sirin A, Emre S, Alpay H, et al. Etiology of chronic renal failure in Turkish children. Pediatr Nephrol 1995;9:549-2.  Back to cited text no. 11  [PUBMED]  
12.Madani A, Fahimi D, Esfehani ST, et al. Glomerular diseases in Iranian children: clinico­ pathological correlations. Pediatr Nephrol 2003; 18:925-8.  Back to cited text no. 12  [PUBMED]  [FULLTEXT]
13.Sipiczki T, Ondrik Z, Abraham G, et al. The incidence of renal diseases as diagnosed by biopsy in Hungary. Orv Hetil 2004;145:1373-9.  Back to cited text no. 13    
14.Brown WW, Peters RM, Ohmit SE, et al. Early detection of kidney disease in community settings: the Kidney Early Evaluation Program (KEEP). Am J Kidney Dis 2003;42:22-35.  Back to cited text no. 14  [PUBMED]  [FULLTEXT]
15.Yap H, Murugasu B, Saw A, et al. Pattern of glomerulonephritis in Singapore children--a renal biopsy perspective. Ann Acad Med Singa­pore 1989;18:35-9.  Back to cited text no. 15    
16.Coppo R, Gianoglio B, Porcellini MG, Maringhini S. Frequency of renal diseases and clinical indications for renal biopsy in children: report of the Italian National Registry of Renal Biopsies in Children. Group of Renal Immuno­pathology of the Italian Society of Pediatric Nephrology and Group of Renal Immuno­pathology of the Italian Society of Nephrology. Nephrol Dial Transplant 1998;13:293-7.  Back to cited text no. 16    

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Correspondence Address:
Sawsan M Jalalah
Pathology Department, College of Medicine, King Abdulaziz University Jeddah
Saudi Arabia
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PMID: 19587501

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