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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
REVIEW ARTICLE  
Year : 2019  |  Volume : 30  |  Issue : 1  |  Page : 15-23
Incidence of pediatric glomerular diseases in Arab world: A systematic review


Department of Allied Health Sciences, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman

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Date of Submission22-Jul-2018
Date of Decision13-Sep-2018
Date of Acceptance13-Sep-2018
Date of Web Publication26-Feb-2019
 

   Abstract 


Despite the high number of Arab children, there are a scanty available data about different types of pediatric glomerular diseases in all Arab countries. Very few Arab countries have a national renal biopsy registry. In this review, we performed a systematic review analyzing the incidence of pediatric glomerular disease in all Arab countries. Relevant manuscripts in all 22 Arab countries found through searches of Medline, Science Direct, Embase and Google Scholar were evaluated. The period was from January 1990 to March 2018. A total of 17 manuscripts containing 3083 renal biopsies from seven countries were analyzed. Male-to-female ratio was 1.3:1. Saudi Arabia revealed the most published studies with seven papers. The average period of the study was 8.63 years. Retrospective studies represent 94.12%. Minimal change disease (MCD) (29.25%), focal and segmental glomerulosclerosis (FSGS) (22.34%), mesangioproliferative glomerulonephritis (14.78%), membranoproliferative glomerulonephritis (6.9%), IgA nephropathy (3.98%), and membranous glomerulopathy (2.65%) were the top types of primary glomerular diseases. The most common types of secondary glomerular diseases were lupus nephritis (36.1%), postinfectious glomerulonephritis (17.62%), congenital nephrotic syndrome (6.08%), Alport syndrome (4.71%), Henoch–Schönlein purpura (1.49%), and amyloidosis (1.36%). In conclusion, MCD and lupus nephritis are, respectively, the most common types of primary and secondary glomerular diseases in children of all evaluated Arab countries. FSGS is the predominant pattern of primary glomerular diseases in Asian Arab countries. The trend of all types of glomerular diseases has not changed in the past 28 years except a noted significant reduction in FSGS. Arab countries are strongly recommended to establish a renal biopsy registry.

How to cite this article:
Alwahaibi NY, Al Issaei HK, Al Dhahli BS. Incidence of pediatric glomerular diseases in Arab world: A systematic review. Saudi J Kidney Dis Transpl 2019;30:15-23

How to cite this URL:
Alwahaibi NY, Al Issaei HK, Al Dhahli BS. Incidence of pediatric glomerular diseases in Arab world: A systematic review. Saudi J Kidney Dis Transpl [serial online] 2019 [cited 2019 May 22];30:15-23. Available from: http://www.sjkdt.org/text.asp?2019/30/1/15/252904



   Introduction Top


There are a total of 22 Arab countries distributed as 12 countries in Asia and 10 in Africa. Recent figures show that the total Arab population is about 422 million and 139.26 million distributed at the age of 0–14 years old.[1] Despite this high number of Arab children, there are only very scanty available data about different types of pediatric glomerular diseases in all Arab countries. Very few Arab countries have a national renal biopsy registry. As the pattern and incidence of adult glomerular diseases differ worldwide, also it does with children. Geographic, socioeconomic, genetic, environmental, racial, gender as well as age contribute to the different types of glomerular diseases.[2] Despite the advanced improvements in the investigation of renal diseases, renal biopsy is still the gold standard for the most correct diagnosis of glomerular diseases.

Knowledge of different types of glomerular diseases in particular with children is very important for better and early management. According to the best of our knowledge, there is no study gathering the incidence of glomerular disease of children in all Arab countries. In this review, we performed a systematic review analyzing the incidence of pediatric glomerular diseases in all Arab countries.


   Materials and Methods Top


Medline, ScienceDirect, Embase, and Google Scholar websites were used to search for pediatrics, children, adolescents, glomerular diseases, glomerulonephritis, glomerulosclerosis, renal biopsy and with one of the following Arab countries: Algeria, Bahrain, Comoros, Djibouti, Egypt, Iraq, Jordan, Kuwait, Lebanon, Libya, Mauritania, Morocco, Oman, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, United Arab Emirates and Yemen. The time period was from January 1990 to March 2018. The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).[3]

As per our inclusion criteria, original reports on children, pediatrics or adolescents, published manuscripts written in English with biopsies diagnosed with light microscope (LM) with or without immunofluorescence (IF) or electron microscope (EM) were included. Theses, review articles, studies written in languages other than English, biopsies those not used LM for diagnosis, reports on adults or elderly only and glomerular diseases reported in transplant or autopsy specimens were excluded. The following information was collected from each included manuscript: Arabic country region, publication year, the name of the journal, time period, study design, number of biopsies, age range or average, gender, type of histopathological diagnosis and frequency of primary and secondary glomerular diseases. In addition, the most common types of primary glomerular diseases such as minimal change disease (MCD), IgA nephropathy (IgAN), mesangioproliferative glomerulonephritis (MesGN), membranoproliferative glomerulonephritis (MPGN), focal and segmental glomerulosclerosis (FSGS) and membranous glomerulopathy (MG) and the most common types of secondary glomerular diseases such as lupus nephritis (LN), amyloidosis (Amyl), Alport syndrome, congenital nephrotic syndrome, Henoch–Schönlein purpura (HSP), and post-infectious glomerulonephritis (PIGN) were included.

The data were analyzed using the Statistical Package for the Social Sciences (SPSS) software version 23 (SPSS Inc., Chicago, IL, USA). Results are presented as numbers, percentages, and means. T-test was used to compare the mean proportion of primary and secondary glomerular diseases at two different period. A P <0.05 was considered statistically significant.


   Results Top


General information

We identified 184 papers, after applying the PRISMA criteria, we excluded 167 papers and included 17 with a total of 3083 biopsies. Only seven Arab countries (31.81%) showed relevant renal data. We could not find relevant manuscripts for Algeria, Bahrain, Comoros, Djibouti, Iraq, Libya, Mauritania, Oman, Palestine, Somalia, Syria, Qatar, Tunisia, UAE, and Yemen. Saudi Arabia revealed the most published studies with seven papers (41.17%). The mean age was 15 years and 5 months. There was an overall male predominance in all studies. Males represented with 57.04% and females with 42.96%. Male-to-female ratio was 1.3:1. Only 5.88% reported prospective studies while the remaining were retrospective (94.12%). The average period of the study was 8.63 years. The years 1999, 2010, 2012, and 2014 showed the most published studies with two manuscripts each. In terms of histopathological diagnosis, 68.75% of the reviewed studies used LM, IF, selected EM or EM for reporting glomerular diseases. Eight papers (47.05%) were published in the Saudi Journal of Kidney Diseases and Transplantation (SJKDT) [Table 1].[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20] The smallest period was four years in Saudi Arabia[4] and the longest period was 19 years in also Saudi Arabia.[13]
Table 1: Characteristics of 17 evaluated studies in Arab countries

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Primary glomerular diseases

Based on 17 studies, there were a total of 2260 cases of primary glomerular diseases in all evaluated Arab countries. MCD (661), FSGS (505), MesGN (334), MPGN (156), IgAN (90), and MG (60) were the top types of primary glomerular diseases. When we separated Arab countries into those from Asia (four countries) and Africa (3 countries), we noticed that FSGS (28.09%) became the predominant pattern of primary glomerular diseases in Asian Arab countries, followed by MesGN (26.28%) and then MCD (21.77%) [Figure 1].
Figure 1: Pattern of primary glomerular diseases in children of Asian and African Arab countries.
FSGS: Focal and segmental glomerulosclerosis, MCD: Minimal change disease, MG: Membranous glomerulopathy, IgAN: IgA nephropathy, MPGN: Membranoproliferative glomerulonephritis, MesGN: Mesangioproliferative glomerulonephritis.


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Secondary glomerular diseases

Based on 12 studies, there were a total of 806 cases of secondary glomerular diseases in all evaluated Arab countries. The most common types of secondary glomerular diseases were LN (291), PIGN (142), congenital nephrotic syndrome (49), Alport syndrome (38), HSP (12), and Amyl (11). When we separated Arab countries into those from Asia and Africa, we noticed that PIGN (19.86%) became the most frequent type of secondary glomerular diseases in Asian Arab countries [Figure 2].
Figure 2: Pattern of secondary glomerular diseases in children of Asian and African Arab countries.
LN: Lupus nephritis, Amyl: Amyloidosis, Alport: Alport syndrome, Congenital: Congenital nephrotic syndrome, HSP: Henoch–Schönlein purpura, PIGN: Postinfectious glomerulonephritis.


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Trends of glomerular diseases

We divided the 28 years evaluated period into two periods: period one from 1990 to 2004 and period two from 2005 to 2018. Based on the evaluation of 17 studies, FSGS showed a significant reduction (P = 0.024) in period 2. Other types of primary glomerular diseases did not show significant changes [Figure 3].
Figure 3: Trend of primary glomerular diseases in children of Arab countries.
FSGS: Focal and segmental glomerulosclerosis, MCD: Minimal change disease, MG: Membranous glomerulopathy, IgAN: IgA nephropathy, MPGN: Membranoproliferative glomerulonephritis, MesGN: Mesangioproliferative glomerulonephritis.


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Based on the evaluation of 12 studies, we did not observe significant changes during the past 28 years with all types of secondary glomerular diseases. Despite the rise in LN during period 2 (40.17%) as compared with 15.67% in period 1, but this increase was not statistically significant [Figure 4].
Figure 4: Trend of secondary glomerular diseases in children of Arab countries.
LN: Lupus nephritis, Amyl: Amyloidosis, Alport: Alport syndrome, Congenital: Congenital nephrotic syndrome, HSP: Henoch–Schönlein purpura, PIGN: Postinfectious glomerulonephritis.


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   Discussion Top


This review evaluated 17 studies from seven different countries with a total of 3083 renal biopsies. Worldwide, MCD is the most common type of primary glomerular diseases in young children.[21] The finding of this study is inline with this global figure as MCD is the most common pattern of primary glomerular disease in studied Arab countries with 29.25%. The lowest incidence was 1.36%% in Jordan[9] and Kuwait,[12] whereas the highest reported incidence was 40.9% in Egypt.[19]

Other studies also report similar findings. In Hong Kong, pediatric renal diseases for 11 years using renal biopsy showed that MCD (50%) and FSGS (17%) were the top types of primary glomerular diseases.[22] In Nepal, where they performed a prospective study over a one year period on 206 pediatric renal biopsies, revealed that MCD (59%) was the predominant pattern of primary glomerular diseases followed by FSGS (12%) and MesGN (11%).[23] In the United Kingdom, MCD was the most frequent pattern of primary glomerular diseases with 80.4%.[24] In the USA, MCD was the most common type of primary glomerular diseases among Caucasian and Hispanic children with 53% and 73%, respectively. However, FSGS was the predominant pattern among African-American children with 47% followed by MCD (36%).[25] Similar finding was also reported in another state in the USA.[26] In Pakistan, where they performed a retrospective study over a six years period on 118 children, showed that MCD (32.2%) was the top pattern of primary glomerular diseases, followed by FSGS (29.66%), MG (8.47%), MPGN (7.62%), and IgM nephropathy (2.54%).[27]

In the current study, MCD was also the most frequent type of primary glomerular diseases in African-Arab countries (Egypt, Morocco, and Sudan) with 36.42%. Other African countries reported similar results. Recent systematic review on histologically proven glomerular disease in African children showed that MCD is the most frequent type of primary glomerular disease followed by FSGS.[28] In Cameroonian children, the top three pattern of primary glomerular diseases were MCD, MG, and proliferative glomerulonephritis with 38%, 31%, and 24%, respectively.[29] In Zaire, MCD remains the top type of primary glomerular disease with 22%, followed by Amyl (18%) and proliferative glomerulonephritis (16%).[30]

In the current study, LN is the most common pattern of secondary glomerular disease with 29.25%. This finding is inline with other similar studies. In China, the top pattern of secondary glomerular diseases in children were LN, purpura nephritis, and HBV-associated glomerulonephritis with 40.7%, 34.3%, and 19.65, respectively.[31] Another study in Hong Kong showed that LN (23%), HSP (8%), and Alport syndrome (3%) were the top pattern of secondary glomerular diseases.[22] In Pakistan, LN (9.32%) was the predominant type of secondary glomerular diseases, followed by PIGN (3.38%) and HSN (2.54%).[27] In Serbia, LN and HSP were the top types of secondary glomerular diseases with 6% and 4%, respectively.[32] Similar findings were also reported in Greek children.[33] Other studies show different findings, in Turkey, HSP (9.17%) was the top pattern of secondary glomerular diseases in children followed by LN (5.42%) and Amyl (1.87%).[34] In Nepal, the top pattern of secondary glomerular diseases in children were PIGN, Alport syndrome, LN and HSP with 33%, 6%, 4% and 0.8%, respectively.[23] LN is also the most common type of secondary glomerular disease in adults.[35],[36],[37],[38] In addition, our very recent review paper shows that LN is the most common type of secondary glomerular disease in adults in Arab countries.[39]

In the past 28 years, it was noticed that the trend of FSGS reduced from 33.33% in the period from 1990 to 2004 to 17.75% in the period from 2005 to 2018. This finding is in disagreement with other study which showed that the incidence of FSGS in children with primary glomerular disease increased from 23% before 1990 to 47% after 1990.[25] This reduction in FSGS could be related to improvements in the socioeconomic condition in some Arab countries.

Several limitations of our study are worth noting. First, 15 Arab countries did not report relevant glomerular studies in children. Second, relatively small number of cases (3083) as compared with the total Arab children (139 million).[1] Third, most of the studies are retrospective (94.12%). Fourth, many nonArab nationalities work in those Arab countries and most of those evaluated papers did not distinguish Arab children from nonArabs. Fifth, there was inconsistency in reporting types of glomerular diseases among Arab countries. Finally, most of the evaluated papers did not classify the age groups and subsequently correlate with the types of glomerular diseases.


   Conclusion Top


MCD and lupus nephritis are the most common types of primary and secondary glomerular diseases in children of all evaluated Arab countries, respectively. FSGS is the predominant pattern of primary glomerular diseases in Asian Arab countries. The trend of all types of glomerular diseases has not changed in the past 28 years excepts a significant reduction in FSGS. Arab countries are strongly recommended to establish a renal biopsy registry.

Conflict of interest:

None declared.



 
   References Top

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Correspondence Address:
Nasar Yousuf Alwahaibi
Department of Allied Health Sciences, College of Medicine and Health Sciences, Sultan Qaboos University, P. O. Box 35, Postal Code 123, Muscat
Sultanate of Oman
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DOI: 10.4103/1319-2442.252904

PMID: 30804262

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