Home About us Current issue Back issues Submission Instructions Advertise Contact Login   

Search Article 
  
Advanced search 
 
Saudi Journal of Kidney Diseases and Transplantation
Users online: 937 Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size 
 

Table of Contents   
LETTER TO THE EDITOR  
Year : 2012  |  Volume : 23  |  Issue : 5  |  Page : 1084-1087
Spectrum of biopsy-proven glomerular disease in Al Qassim region: A single centre experience


1 Department of Medicine, Division of Nephrology, King Fahd Specialist Hospital Buraida, AlQassim, Saudi Arabia
2 Department of Medicine, Section of Nephrology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
3 Department of Pathology, King Fahd Specialist Hospital Buraida, AlQassim, Saudi Arabia

Click here for correspondence address and email

Date of Web Publication13-Sep-2012
 

How to cite this article:
Saleemi AN, Nabi Z, Ali S, Salloom A, El Nasri A, Albaqumi M. Spectrum of biopsy-proven glomerular disease in Al Qassim region: A single centre experience. Saudi J Kidney Dis Transpl 2012;23:1084-7

How to cite this URL:
Saleemi AN, Nabi Z, Ali S, Salloom A, El Nasri A, Albaqumi M. Spectrum of biopsy-proven glomerular disease in Al Qassim region: A single centre experience. Saudi J Kidney Dis Transpl [serial online] 2012 [cited 2020 Jun 4];23:1084-7. Available from: http://www.sjkdt.org/text.asp?2012/23/5/1084/100963
To the Editor,

Globally, glomerular diseases continue to be a leading cause of end-stage renal disease, therefore it is important to recognize the pattern of glomerular disease in any given geo­graphical area, which will help to lay down appropriate strategies for future management plans. The exact pattern of glomerulonephritis in Saudi Arabia is not clearly known as the majority of the studies have reported conflic­ting results. [1],[2],[3],[4],[5],[6],[7] It is interesting to note that focal segmental glomerulosclerosis (FSGS), [1],[5] membranoproliferative glomerulonephritis (MPGN), [3],[4] membranous glomerulonephritis [7] and mesangioproleferative glomerulonephritis [2] have been reported as the most common glomerular disease patterns in different studies conducted in this part of the world. The possible reasons for these wide variations could be the small number of patients in many studies, referral bias, possible geographical differences and lack of necessary facilities for accurate diagnosis (such as electron microscopy and trained nephro-histopathologist). Till now, there are no reports regarding the pattern of glomerulo-nephritis in Al Qassim region, Therefore, we carried out a retrospective analysis of renal biopsies performed during the last five years in the King Fahd Specialist Hospital, Buraida, the only center conducting renal biopsies in the Al Qassim region. Records of renal biopsies carried out at the King Fahd Specialist Hospital Buraida, Al Qassim, from January 2005 till January 2010, were retrospectively examined. We recorded the following data for each patient: age, gender, indication of renal biopsy, renal functions at the time of biopsy and histopathological diag­nosis. All the biopsies till 2007 were reported on the basis of light microscopy only and, immunofluorescence (IF) was used for biopsies done after 2007. Electron microscopy was not done due to non-availability. Statistical ana­lysis was done using SPSS 16.0. Chi-square test was used for comparison of qualitative data (age, indication of biopsy, histological findings and serum creatinine). Statistical sig­nificance was considered as P <0.05.

Of 126 renal biopsies reviewed, 56 (44.4%) were male and 70 (55.6%) were female. Age of the patients ranged between 12 and 80 years (mean ± S.D was 31 ± 14.3). Maximum number of patients, i.e. 79 (63%), were in the age group of 15-34 years. The most common indication of renal biopsy was nephrotic syn­drome (NS), 62 (49.2%), followed by subnephrotic proteinuria (SNP), 32 (25.4%). The most common histopathological diagnoses were lupus nephritis (LN), 31 (24.6%), and FSGS, 30 (23.8%). Renal functions were normal in 87 (69%) and abnormal in 39 (31%) patients at the time of biopsy.

Comparison was made according to gender for age, indication of biopsy, histological fin­dings and serum creatinine. Age difference among males and females was not statistically significant (P >0.05) [Table 1]. SNP was the most common indication for renal biopsy in females (35.7%) as compared with males (12.5%) (P <0.05) [Table 2]. LN was more common in females (38.6%) as compared with males (12.5%) (P <0.05), whereas FSGS was more common in males (35.7%) as compared with females (14.3%) (P <0.05) [Table 3]. Male patients had more abnormal renal functions at the time of biopsy (44.6%) as compared with females 20% (P <0.05) [Table 4]. Our study is the first ever from this region of Saudi Arabia highlighting the spectrum of glomerular diseases encountered in the Al Qassim region. Our study once again confirmed FSGS (23.8%) as a leading primary glomerular pa­thology, similar to what has been reported pre­viously by Qunibi et al (30.7%) from the King Faisal Specialist Hospital & Research Centre, Riyadh. [1] A similar result but in a larger num­ber of patients was later reported by Akhtar et al from the same institute. [5] The higher preva­lence of FSGS in both these studies, and also ours, could be due to referral bias as both hospitals are tertiary care centers and there is a possibility that many biopsies were done for steroid-resistant minimal change disease (MCD). Mitwalli et al [6] also reported a high prevalence of FSGS (40.8%), [6] whereas Jorgenson et al [2] reported the lowest prevalence of FSGS (4%) from the southern part of Saudi Arabia. Jalalah [7] from the western region of Saudi Arabia re­ported FSGS to be 21.3%, although membra­nous nephropathy (25.7%) was the leading cause noted, which is in contrast to our obser­vation, where we found membranous nephropathy to account for 11.3% cases only. FSGS has also been reported to be the leading glomerulopathy (39.8%) in a study from Pakistan, [8] and 18% reported by El Rashaid from Kuwait. [9] The other aspect that could be responsible for this wide variation is absence of uniformity in interpreting the biopsies due to lack of IF and EM. Interestingly, FSGS was found to be more common in males as compared with females in our study, which is mentioned before as well. Another alarming observation noted in our study is the fact that LN was the most common cause of glomerulopathy (24.6%) and, of course, the leading cause of secondary glomerulonephritis (GN). A similar observation was made by Huraib et al, [10] where LN accounted for 57% of the cases of secondary GN. Similar results were noted in a study from Bahrain, where LN was the leading cause of secondary GN [11] and also from Korea, [12] but in both these studies percentages of LN were lesser than that noted in our study. This could be due to envi­ronmental and genetic factors as some areas in Saudi Arabia are well known to have a very high prevalence of LN.
Table 1: Age and gender distribution.

Click here to view
Table 2: Indication of biopsy according to gender.

Click here to view
Table 3: Histological findings on biopsy according to gender.

Click here to view
Table 4: Serum creatinine according to gender.

Click here to view


Interestingly, SNP was more common in females as an indication of biopsy as com­pared with males (P <0.05); this could be explained by the fact that many biopsies in females were done for LN where the initial presentation was SNP. Serum creatinine was abnormal in a higher proportion of male pa­tients (P <0.05), which could be due to a higher muscle mass and the fact that FSGS was also more common in males as compared with females.

Ours is a pioneering study from this region of Saudi Arabia with an attempt to ascertain the spectrum of glomerulopathy. The results should be interpreted with caution as it was a retros­pective review, IF and EM were missing in many biopsies and interpreting histopathologist were also not the same. Our study again has shown the importance of renal registry data and a way to ensure uniformity in interpreting renal biopsies and more cooperation with higher centers to ensure proper interpretation of renal biopsies.

 
   References Top

1.Qunibi W, al Saibai M, Taher S, Akhtar M. Renal disease in Saudi Arabia: a study of 147 renal biopsies. King Faisal Spec Hosp Med J 1984;4:317-23.  Back to cited text no. 1
    
2.Jorgenson HE, Malik GH, Paul TT, Wohra PC. Renal disease in Saudi Arabia. Ann Saudi Med 1990;10:37-44.  Back to cited text no. 2
    
3.Huraib SO, Abu-Aisha H, Mitwalli A, Mahmoud K, Memon NA, 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.  Back to cited text no. 3
    
4.Al-Khader A, Al Sulaiman M, Dhar JM. Renal histology in Saudi population with overt nephrotic syndrome. Ann Saudi Med 1990;5: 581.  Back to cited text no. 4
    
5.Akhtar M, Qunibi W, Taher S, et al. Spectrum of renal disease in Saudi Arabia. Ann Saudi Med 1990;10:37-44.  Back to cited text no. 5
    
6.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. 6
    
7.Al Shohaib S, Nassif O, Jalal S. The patterns of renal disease in the western part of Saudi Arabia. Saudi Kidney Dis Transplant Bull 1990;4:563.  Back to cited text no. 7
    
8.Kazi JI, Mubarak M, Ahmed E Naqvi SA, Rizvi SA. Spectrum of glomerulonephritides in adults with nephritic syndrome in Pakistan. Clin Exp Nephrol 2009;13:38-43.  Back to cited text no. 8
    
9.El- Reshaid W, El- Reshaid K, Kapoor MM, Madda JP. Glomerulopathy in Kuwait:the spec­trum over the past 7 years. Ren Fail 2003; 25:619-3  Back to cited text no. 9
    
10.Huraib S, Al Khader A, Shaheen FA, et al. The spectrum of glomerulonephritis in Saudi Arabia: The result of the Saudi registry. Saudi J Kidney Dis Transpl 2001;12:157-63.  Back to cited text no. 10
    
11.Al Arrayed A, George SM, Malik AK, et al. The spectrum of glomerular disease in Kingdom of Bahrain: an epidemiological study based on renal biopsy interpretation. Transplant Proc 2004;36:1792-5.  Back to cited text no. 11
[PUBMED]    
12.Chang JH, Kim DK, Kim HW, et al. Changing prevalence of glomerular diseases in Korean adults: a review of 20 years of experience. Nephrol Dial transplant 2009;24:2406-10.  Back to cited text no. 12
[PUBMED]    

Top
Correspondence Address:
Zahid Nabi
Department of Medicine, Section of Nephrology, King Faisal Specialist Hospital and Research Center, Riyadh
Saudi Arabia
Login to access the Email id


DOI: 10.4103/1319-2442.100963

Rights and Permissions



 
 
    Tables

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



 

Top
   
 
 
    Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  
 


 
    References
    Article Tables
 

 Article Access Statistics
    Viewed1426    
    Printed36    
    Emailed0    
    PDF Downloaded257    
    Comments [Add]    

Recommend this journal