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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
RENAL DATA FROM THE ARAB WORLD  
Year : 2017  |  Volume : 28  |  Issue : 3  |  Page : 571-578
Pattern of acute glomerulonephritis in adult population in Dubai: A single-center experience


1 Department of Nephrology, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
2 Department Nephrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
3 Department of Pathology, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates

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Date of Web Publication18-May-2017
 

   Abstract 

Epidemiological data of renal diseases have great geographic variability throughout the world. Due to the lack of a national renal data registry system, there is no information on the prevalence rate, clinical and pathological features of various glomerulonephritis (GN) in the United Arab Emirates (UAE). In a retrospective cross-sectional study, we analyzed 158 renal biopsies done in Dubai Hospital, UAE, between the years of 2005 and September 2014, with an aim to determine the prevalence rate and frequency of different pathological patterns of GN in adult patients who presented with proteinuria ± hematuria. In our study, primary GN still remains more common than secondary GN (66.4% vs. 33.5%). Among the primary GN in our analysis, minimal change disease was the most common primary GN affecting 20% of the study population (13.2% of the total GN causes) followed with membranous GN (18.2%), then membrano- proliferative GN (15.3%) and focal segmental glomerulosclerosis (13.46%), while among the secondary causes lupus nephritis (LN) is the most prevalent GN in UAE, predominantly in the Emirati national population whom constituted 48% of total biopsies. Indeed, LN had the highest incidence among all types of GN even the primary ones, constituting 23.4% of total GN in Dubai (74% of the total secondary causes). Furthermore, systemic lupus erythematosus was the most common GN in women while the minimal change was widely affecting male patients. Among elderly, the most common pathology was diabetic glomerulosclerosis followed by amyloidosis.

How to cite this article:
Alhadari AK, Alalawi FJ, Seddik AA, Zahra K, Kumar D, Yousif H, Alnour H, Jansen M, Railey MJ. Pattern of acute glomerulonephritis in adult population in Dubai: A single-center experience. Saudi J Kidney Dis Transpl 2017;28:571-8

How to cite this URL:
Alhadari AK, Alalawi FJ, Seddik AA, Zahra K, Kumar D, Yousif H, Alnour H, Jansen M, Railey MJ. Pattern of acute glomerulonephritis in adult population in Dubai: A single-center experience. Saudi J Kidney Dis Transpl [serial online] 2017 [cited 2019 Nov 20];28:571-8. Available from: http://www.sjkdt.org/text.asp?2017/28/3/571/206443

   Introduction Top


Epidemiological data of renal diseases have great geographic variability. Due to the lack of a national renal data registry system, there is no information on the prevalence rate, clinical and pathological features of various glome- rulonephritis (GN) in the United Arab Emirates (UAE).

In a retrospective cross-sectional study, we analyzed 158 renal biopsies done in Dubai Hospital, UAE, between the years of 2005 and September 2014. We determined the prevalence rate and the frequency of different pathological patterns of GN in adult patients who presented with proteinuria ± hematuria.


   Materials and Methods Top


All kidney biopsies which were analyzed at the Pathology Department of Dubai hospital between the years 2005 and September 2014 were studied retrospectively. A total of 258 kidney biopsies were evaluated. Indications of kidney biopsies were nephrotic syndrome in all patients over 12 years of age, persistent proteinuria of more than 1 g/24 h with or without hematuria, isolated hematuria after excluding urological causes, systemic diseases with renal involvement, failure to recover from assumed reversible acute kidney injury, unexplained renal failure with normal-sized kidneys, and in diabetic patients if renal manifestation atypically early (<10 years) in type 1, or there are dysmorphic erythrocytes and/or red cell cast and/or rapid unexplained deterioration of the renal function in the diabetic patients.

The biopsy specimens were processed for light and immunofluorescence microscopy; a few cases were processed for electron microscopy.


   Results Top


A total of 258 biopsies were evaluated; sub- optimal biopsies, transplant biopsies, and biopsies that confirmed tubular/interstitial diseases were excluded, biopsies of children younger than 12 years were also excluded from the study. The remaining total biopsies representing adults with GN were 158 in our center.

The average patient’s age was 33 (range: 12–81 years). Among 158 cases, 84 were male (53.1%) while 74 were female (46.8%). 5.69% were elderly >60 years of age, 105 (66.4%) patients had primary GN while 53 (33.5%) had secondary GN.

The most common GN in our center was lupus nephritis (LN) (23.4%) as shown in [Figure 1], followed by minimal change GN (MCD) (13.2%) then membranous GN (MGN) (12%), membranoproliferative GN (MPGN) (10.1%), and focal segmental glomeruloscle- rosis (FSGS) (8.8%) of the total GN cases.
Figure 1: Pattern of GN in adult population in Dubai hospital.
SLE: Systemic lupus erythematosus, GN: Glomerulonephritis, MPGN: Membranoproliferative glomerulonephritis,
FSGS: Focal segmental glomerulosclerosis, DM: Diabetes mellitus, HTN: Hypertension.


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If we subclassify the primary lesions only; we will find MCD is the predominant primary GN affecting 20% of the study population (13.2% of the total GN causes) followed by MGN (18.2%), then MPGN (15.3%) and FSGS (13.46%) of the primary GN lesions [Figure 1].

Moreover, among the males, only MCD was predominantly the most common pathology (19%) followed by FSGS (11.9%), and then lupus (9.52%), MPGN (9.52%), membranous (9.52%) and IgA nephropathy (9.52%) all in equal percentages.

While in females, the most common GN were lupus (39.7% of all female GN lesions), followed by MGN (15%), MPGN (10.9%), and then minimal change GN (9.5%) [Figure 2].
Figure 2: GN distribution based on sex.
GN: Glomerulonephritis, SLE: Systemic lupus erythematosus, MPGN: Membranoproliferative glomerulonephritis, MCD: Minimal change disease, FSGS: Focal segmental Glomerulosclerosis.


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Among elderly, the most common pathology was diabetic glomerulosclerosis followed by amyloidosis [Figure 3].
Figure 3: Secondary GN distribution.
GN: Glomerulonephritis, SLE: Systemic lupus erythematosus, DM: Diabetes mellitus.


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Among all patients, the local Emirati patients were 76 of the total biopsied patients in our center (constituted 48% of total biopsies). LN was the most prevalent pathology among them (51% as compared to 49% of other nationalities) [Figure 4].
Figure 4: The pattern of GN among UAE population.
GN: Glomerulonephritis, UAE; United Arab Emirates, SLE: Systemic lupus erythematosus, MPGN: Membranoproliferative GN, MGN: Membranous GN, FSGS: Focal segmental glomerulosclerosis, DM: Diabetes mellitus, HUS: Hemolytic-uremic syndrome.


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   Discussion Top


This study examines the frequency of acute GN in adult population in a single center in Dubai, UAE. To the best of our knowledge, this is the first study in UAE identifying the epidemiology of each type of GN in Dubai although it has its limitation that it involves only a single center, this hospital is one of the biggest and busiest hospitals in UAE where multinationality patients being seen. Among our studied biopsies, 76 were local UAE nationals while the remaining were expatriate; hence, these data will reflect both together.

Our data demonstrated similar epidemio- logical variations compared to other countries, particularly neighboring Gulf countries with mild differences in the frequency of each primary GN.

In our study, primary GN collectively was more common than secondary GN (66.4% vs. 33.5%), which are consistent with global results. Among the secondary causes, LN is the most prevalent GN in UAE, predominantly in the national population. Indeed, LN had the highest incidence among all types of GN even the primary ones, constituting 23.4% of total GN in Dubai (74% of the total secondary causes). This could be attributed to environmental factors in genetically predisposed patients.

Systemic lupus erythematosus (SLE) in our study was followed by minimal change GN (13.2%) then MGN (12%), MPGN (10.1%) and FSGS (8.8%). Furthermore, SLE is the commonest GN in women while minimal change is widely affecting male patients.

Our registry is comparable to data from Emirate of Abu Dhabi/UAE; published in 1998 that LN had constituted 40.7% of the secondary GN lesions.[1] This report was dating back to 1998, but apparently, this is the only available published data from UAE.

Our data were comparable to neighboring Arab countries in addition to data related to other surrounding regions in the sense that SLE is superseding secondary GN in most of such countries. Moreover, the neighboring Arab countries share similar environmental and genetic properties. This is mainly due to the fact that those countries are directly related in geography, common daily practices, and living conditions, especially when it comes to marriage, which usually happens within narrow tribal ties. In Oman for example; LN had affected 36.15% and 30.4% of the total GN in two published studies in Muscat exceeding the primary GN types,[2],[3] Similarly in Cairo/Egypt LN had affected 28.57% of total GN,[4] in Bahrain LN was 38.9% of the secondary GN,[5],[6],[7] also it was the commonest secondary GN in Kuwait,[8],[9] and it affected 45.5% in Iraq,[10] 11% in Iran,[11] 44% in Pakistan,[12] and 88.5% in Thailand.[13] In Saudi Arabia there are variable reported incidences that varied in different areas with higher prevalence of LN in Riyadh (48.5% and 54.4% in 2 centers) and eastern part of Saudi Arabia (36%), however; the estimated total incidence of LN as per Saudi registry in 2000 had reached 57% of the secondary GN lesions.[14],[15],[16],[17]

In Jordan, Wahbeh et al had reported in 2008 that LN is the commonest secondary GN that correspond to 26.6% of his study sample.[18] Whether this is a change in the trend of secondary GN in Jordan or an incidental finding in his center only could be controversial, since the previous reports by Wahbeh et al[18] in 2008 and Said[19] in the year 2000 had estimated that amyloidosis of various etiologies was the most common secondary GN affecting 40.7% of his study population; which is logical in Jordan reflecting the high prevalence of FMF in this country, followed with systemic lupus nephritis (SLE) in 21 patients (38.8% of secondary GN cases). Perhaps, a new data registry is needed to answer this.

In contrast in Qatar, diabetic nephropathy was the most common secondary GN followed by lupus (50%, and 35%, respectively).[20] In our data, diabetic nephropathy is the second common secondary GN [Figure 4]; equivalent to 14% of the secondary GN (4.4% of the total GN), and this compatible with data from other countries; however, we think this is an underestimate of the true incidence of diabetic nephropathy in our population, especially with the knowledge that UAE is ranked 16th worldwide on the prevalence of diabetes in 2015 with diabetic estimation that crossed 19% among UAE population.[21],[22],[23],[24] The fact that kidney biopsy is performed in diabetic patients only if there is suspicion about the diagnosis of nephropathy could explain this low number.

Among the primary GN in our analysis, MCD was the most commonest primary GN affecting 20% of the study population (13.2% of the total GN causes) followed with MGN (18.2%), then MPGN (15.3%) and FSGS (13.46%) of the primary GN lesions. Furthermore, minimal change was noticed to predominate in male patients.

FSGS was the fourth most common primary GN in our data. However, if we consider that MCD and FSGS are possibly one entity and that FSGS can be easily misdiagnosed as MCD, then definitely the frequency will be much higher, and thus MCD/FSGS will be the leading primary GN disorder in our study.

If we compare this to neighboring countries; we will find that spectrum of MCD-FSGS is the leading primary GN in Oman, Kuwait, Qatar, central and eastern regions of Saudi Arabia, Bahrain (however, authors in Bahraini data had included children in their data analysis), Iraq and Pakistan.[2],[3],[5],[6],[7],[8],[10],[12],[14],[15],[16],[17],[18],[25],[26]

Indeed, this is comparable with the global trends of increasing the frequency of FSGS worldwide. Dragovic et al in 2005 in his analysis of New York population (singlecenter study) noticed that the incidence of FSGS as a proportion of primary GN had increased significantly in the latest years, especially between his analysis period of 19982002 and that increase has occurred among all; white, black and Hispanic patients. In addition, FSGS in his study sample was most prevalent in patient’s >45 years.[27] Similarly, other reports from the USA, South American countries and Republic of Macedonia had reported same.[28],[29],[30],[31]

Furthermore, Parichatikanond (2006) in his analysis of 3555 cases of renal biopsy in Thailand, he noticed that despite IgM were still the common primary GN. In Thailand, yet, there was a significant increase in the prevalence of focal and segmental glomeruloscle- rosis in examination over five-year interval period, which rose by five times over the last two decades in contrast to IgM nephropathy, which prevalence is decreasing.[13]

Idiopathic MGN, which was reported by Yahya to be the most common primary GN in Abu Dhabi in 1998;[1] is the second primary GN in our data analysis and had constituted 18.2% among the primary GN (12% of total GN). Whether this is a change in the trend of primary GN since 1998 or an isolated finding in our center since Dubai has more multinational residents of different ethnic background, and this could reflect the primary GN in their native countries. Perhaps, a new national registry can answer this. Interestingly, MGN is the most common primary GN in Iran and Western region of Saudi Arabia. [11],[28],[32]

IgA nephropathy is reported in only 10 patients in our study (constituting 9.7% of primary GN), (out of those only one patient was national male, while the rest were expatriate of different nationalities), denoting that IgA nephropathy is not common in our country as the case in the Caucasian population. Similarly, reports from neighboring countries such as Oman, certain areas of Saudi Arabia, Bahrain, Kuwait, Iraq, and Iran[2],[5],[6],[7],[8],[10],[11],[14],[17],[32] illustrated lower frequencies of IgAN among the primary glomerular disease compared to reports from Europe,[33],[34],[35] where the IgA is the leading cause of glomerular disease, Australia, Brazil, and the Far East region.[13],[30],[36],[37],[38],[39],[40] Whether these data show the real incidences of IgAN or is an underestimate of the actual percentage, as many as 30% of those cases can present with advance kidney damage that necessities urgent dialysis, making kidney biopsy worthless at the time of presentation.


   Conclusions Top


These data make a small contribution to the epidemiology of GN in UAE; showing mild epidemiological differences from that reported from other countries. It was observed that LN is the most prevalent GN in UAE, particularly among the national population.

Furthermore, SLE is the most common GN in women while minimal change is widely affecting male patients; however, this is a singlecenter unit data; hence, these data cannot be expected to reflect the spectrum of diseases in UAE. A multicenter study with a larger sample size should be performed to create a registry of UAE renal biopsies.

 
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Correspondence Address:
Amna K Alhadari
Department of Nephrology, Dubai Hospital, Dubai Health Authority, Dubai
United Arab Emirates
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DOI: 10.4103/1319-2442.206443

PMID: 28540895

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