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: 2432 Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size 
 


 
Table of Contents   
ORIGINAL ARTICLE  
Year : 2019  |  Volume : 30  |  Issue : 3  |  Page : 628-633
Pattern of renal diseases and the need for establishment of renal biopsy registry in Saudi Arabia


1 Department of Medicine, Nephrology Division, Aseer Central Hospital, Abha, Saudi Arabia
2 Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
3 Department of Medicine, King Fahad University Hospital, Dammam, Saudi Arabia
4 Department of Nephrology, Armed Forces Hospital, Riyadh, Saudi Arabia
5 Department of Nephrology, King Khalid University Hospital, Riyadh, Saudi Arabia
6 Department of Pathology, National Guard Hospital, Riyadh, Saudi Arabia
7 Department of Medicine, Nephrology Division, Security Forces Hospital, Riyadh, Saudi Arabia
8 Department of Pediatric, King Abdulaziz Hospital, Jeddah, Saudi Arabia

Click here for correspondence address and email

Date of Submission23-Mar-2018
Date of Decision02-Jun-2018
Date of Acceptance02-Jul-2018
Date of Web Publication26-Jun-2019
 

   Abstract 


Renal disease is a common medical problem in Saudi Arabia. Varieties of renal lesions if not treated properly or not discovered early will lead to a chronic kidney disease. Identifying the types of renal lesions can help in identifying the high-risk patients and appropriate treatment can be provided. Glomerulonephritis (GN) is considered one of the leading causes of end-stage renal disease in Saudi Arabia. The prevalence of different renal lesions were identified by different reports; however, these reports showed inconsistency. One important reason for such differences is related to the lack of unified methods in diagnosing and processing renal tissues and to the fact that different reports were reported by different pathologists. In addition, the differences in the reported results may reflect patient selection biases for renal biopsy or to the different policies and protocols adopted by different nephrologists. This is a prospective, multicenter study that involves different patients from different institutes and from different regions in Saudi Arabia to delineate the pattern of renal diseases based on renal biopsies. Four hundred and five cases were selected and studied over two years. This preliminary report shows that the most common primary renal lesion in Saudi Arabia is focal segmental glomerulosclerosis in 24.1%, followed by IgA nephropathy (15.2%), mesangioproliferative non-IgA, (13.2%), and membranoproliferative GN (12.4%). Lupus nephritis was the most common cause of secondary GN in 66% of the secondary causes.

How to cite this article:
Al-Homrany M, Alghamdi S, Al-Hwiesh A, Mousa D, Alwakeel J, Mitwalli A, Alsaad K, Alharbi A, Kari J. Pattern of renal diseases and the need for establishment of renal biopsy registry in Saudi Arabia. Saudi J Kidney Dis Transpl 2019;30:628-33

How to cite this URL:
Al-Homrany M, Alghamdi S, Al-Hwiesh A, Mousa D, Alwakeel J, Mitwalli A, Alsaad K, Alharbi A, Kari J. Pattern of renal diseases and the need for establishment of renal biopsy registry in Saudi Arabia. Saudi J Kidney Dis Transpl [serial online] 2019 [cited 2019 Sep 18];30:628-33. Available from: http://www.sjkdt.org/text.asp?2019/30/3/628/261335



   Introduction Top


The prevalence of renal diseases in Saudi Arabia is high, although true incidence of endstage renal disease (ESRD) is not well documented. It is thought that it is higher than reported.[1] Most of the cases approaching ESRD are labeled either of unknown cause or due to hypertensive nephrosclerosis.[2] The practice has shown that these cases are likely due to chronic glomerulonephritis (GN), and they were either missed or undiscovered at early stages and did not receive a proper medical treatment. Because GN contributes to a high percentage of the causes of chronic kidney diseases, identifying the types and the high-risk group is the first step toward providing adequate and proper treatment aiming to reduce the number of patients reaching ESRD. Renal biopsy is considered the main source of reference for the diagnosis of renal diseases. In addition, it helps to understand the prognosis of different lesions and to provide patients with appropriate therapy. Several retrospective studies were published from Saudi Arabia regarding the pattern of pathological lesions in the Kingdom and concluded that focal segmental glomerulosclerosis (FSGS) is the predominant lesion (15%–36.6%).[3],[4],[5] However, others suggested that membranopro-liferative GN is the most common pathological lesion found (26.4%–38%).[6],[7] IgA nephro-pathy, a very common disease worldwide, was reported in these studies with variable prevalence levels (6.5%–19%).[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13] The prevalence of membranous lesion was reported to be between 2.5% and 10.6%.[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13] These variations of the prevalence of different glomerular lesions were not only observed between different centers but also within the same center reporting different results.[7],[9],[10],[11] Several factors contribute to the discrepancies between different reports such as these reports were retrospective studies (hospital based), some of these reports were lacking immunofluore-scence (IF), light microscopy (EM) studies, the histopathological findings were reported by different pathologists, the indication of kidney biopsies was not unified between different centers, and some of these centers are known to be referral centers for difficult cases which may have created some bias regarding the common pathological lesions. Based on this background, a group of interested nephro-logists from different institutes and different regions in the kingdom gathered and have agreed on one protocol, outlined the indications of renal biopsied to be followed and the samples of renal tissues to be read by experienced pathologists. The aim of the study is to study all the biopsied cases and to report the pathological findings as well as the clinical presentation of each case.


   Materials and Methods Top


This is a collaborative, prospective, multicenter study. Data were collected from various hospitals participating in the study. All are Saudi patients who underwent renal biopsies for different indications. The data collected included clinical, laboratory, and histopatho-logy reports. One unified form that includes relevant medical and laboratory information was used by all the involved hospitals. A coding system for pathological diagnosis was established and used by different pathologists. Renal tissues were processed for LM, IF, and electron microscopical examination. Hospitals participated in this study were as follows: Aseer Central Hospital (Abha), King Faisal Specialist Hospital (Jeddah), National Guard Hospital (Riyadh), Riyadh Military Hospital (Riyadh), Security Forces Hospital (Riyadh), King Abdulaziz University Hospital (Jeddah), King Fahd University Hospital (Dammam), and King Khalid University Hospital (Riyadh). All patients had given consents for renal biopsy.


   Results Top


During the period from August 2010 to July 2012, 405 cases of renal biopsied were collected from different institutes. [Table 1] shows the frequencies of cases per hospital participated in the current study. Of 405 cases, there were 209 (51.6%) males and 196 (48.4%) females. All cases were Saudi nationals. Three hundred and thirty-nine (83.7%) patients were above the age of 12 years and 66 (16.3%) were pediatric age group (12 years and below). Fifteen (3.7%) cases had a positive family history of renal diseases of different types.
Table 1: Number of cases per hospital participated in the study.

Click here to view


[Table 2] shows the frequencies of different types of renal pathology. Primary glomerular diseases constituted 61.7% whereas secondary GN was found in 25.4%, followed by tubulo-interstitial diseases in 4.4% and vascular cases in 2.5%. [Table 3] shows the frequencies of different renal lesions among all study groups. FSGS was reported to be the most common primary renal lesions in 24.1 %, followed by IgA nephropathy in 15.2%, Mesangioprolife-rative (non-IgA) in 13.2%, and membrano-proliferative in 12.4% in all biopsied cases. Lupus nephritis (LN) was shown to be the most common lesion of secondary GN in 66% of the cases. [Table 4] shows the pattern of different renal lesions among children (age <12 years old); it shows that FSGS is the most common lesion in 18.2%, followed up by minimal change (13.6%) and IgM nephropathy (13.6%). Most of these cases were considered as steroid-resistant cases; therefore, an element of bias does exist in this report. [Table 5] indicates the prevalence of different renal lesions among adult age group. FSGS (14.2%) followed by membranous nephropathy (11.5%) was the most common primary lesion in this age group. With regard to regional variations, our report showed some differences in the prevalence of primary GN: membranoprolife-rative lesion (19.3 %) was prevalent in the southern region, IgA nephropathy (23%) was the most common in eastern region, while FSGS was the main lesion reported from central and western regions (20% and 16.9%, respectively). Hepatitis C and B were positive in 0.7% and 0.5% of cases, respectively. Hypertension was observed in 45% of all FSGS and 51.6% of the membranoprolife-rative cases. Twenty-seven percent of FSGS and 25% of the membranoproliferative GN cases presented with different degrees of impaired kidney function.
Table 2: Distribution of differential renal pathology.

Click here to view
Table 3: Frequencies of different renal lesions among the study group.

Click here to view
Table 4: Frequencies of different renal pathology among pediatric age group.

Click here to view
Table 5: Frequencies of different renal pathology among adult population (age >12 years old).

Click here to view



   Discussion Top


This is the first prospective multicenter study in Saudi Arabia conducted to investigate the prevalence of different renal lesions based on a unified protocol for kidney biopsy involving different institutes in Saudi Arabia. The aim of the study was to provide a base for possible establishment of renal biopsy registry. The establishment of such registry based on agreeable database and standard criterion should help to provide the health workers and the decision makers with the correct data needed to do more collaborative work and to compare the results with the already established registries in different parts of the world.[14],[15],[16],[17],[18] This preliminary report showed the prevalence of different renal lesions in both adult and children as well as the frequencies of various renal lesions observed in different regions in Saudi Arabia. Our results indicated that the most common renal lesion observed was FSGS (24.1%), IgA (15.2%), mesangioproli-ferative, non-IgA, (13.2%), and membrano-proliferative GN (12.4%). LN was the most common secondary lesion in 66%. This report is in accordance with earlier reports which showed that FSGS was the most common renal lesion in 15%–36.6%.[3],[4],[5] Other important finding in these preliminary data was the findings of the pattern of renal diseases in pediatric age group. Minimal change nephro-pathy is well known as the primary GN in children and kidney biopsy is usually not performed in pediatric age group. Often, patients who do not respond to corticosteroid will need kidney biopsy to rule out other pathology. In this report, 18.2% of the biopsied cases in children were found to have FSGS and 18.2% were mesangioproliferative GN (non-IgA), most of these cases had kidney biopsies for obvious reason like being steroid unresponsive. There was some regional variations observed in this study, which cannot be explained solely by biopsy indication bias, as this was avoided by applying one protocol in all hospitals involved in the study from different regions. Genetic, familial, and environmental factors are associated with different forms of glomerular diseases. These factors may have led to such differences observed in the current report.


   Conclusion Top


This preliminary report showed the need to keep registering all kidney biopsies in the kingdom and to establish a renal biopsy registry. The registry should provide the interested researchers with the proper materials needed to do further research on different glomerular lesions.

Conflict of interest: None declared.



 
   References Top

1.
Al-Homrany M, Abolfotoh M. Incidence of treated end-stage renal disease in Asir region, Southern Saudi Arabia. Saudi J Kidney Dis Transpl 1998;9:425-30.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Saudi Center for Organ Transplantation 2016. Annual Report; 2016.  Back to cited text no. 2
    
3.
Nawaz Z, Mushtaq F, Mousa D, et al. Pattern of glomerular disease in the Saudi population: A single-center, five-year retrospective study. Saudi J Kidney Dis Transpl 2013;24:1265-70.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Alkhunaizi AM. Pattern of renal pathology among renal biopsy specimens in Eastern Saudi Arabia. Saudi Med J 2007;28:1676-81.  Back to cited text no. 4
    
5.
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.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
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. 6
    
7.
Mitwalli AH, Al Wakeel JS, Al Mohaya, et al. Pattern of glomerular disease in Saudi Arabia. Am J Kidney Dis 1996;27:797-802.  Back to cited text no. 7
    
8.
Alhomrany M. Pattern of renal diseases among adults in Saudi Arabia: A clinico-pathological study. Ethn Dis 1999;9:463-67.  Back to cited text no. 8
    
9.
Huraib S, Abu-Aisha H, Mitwalli A, Mahmood K, Memon N, Suliman F. The spectrum of renal disease found by kidney biopsies at King Khalid university hospital. Kidney Dis Transplant Bull 1990;1:15-9.  Back to cited text no. 9
    
10.
Al Wakeel JS, Mitwalli AH, Tarif N, et al. Spectrum and outcome of primary glomerulonephritis. Saudi J Kidney Dis Transpl 2004;15:440-6.  Back to cited text no. 10
    
11.
Mitwalli AH, 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. 11
[PUBMED]  [Full text]  
12.
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. 12
[PUBMED]  [Full text]  
13.
Mousa DH, Al-Hawas FA, Al-Sulaiman MH, Al-Khader AA. 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. 13
[PUBMED]  [Full text]  
14.
Gesualdo L, Di Palma AM, Morrone LF, Strippoli GF, Schena FP; Italian Immunopathology Group, Italian Society of Nephrology. The Italian experience of the national registry of renal biopsies. Kidney Int 2004;66:890-4.  Back to cited text no. 14
    
15.
Heaf J. The Danish renal biopsy register. Kidney Int 2004;66:895-7.  Back to cited text no. 15
    
16.
Rivera F, López-Gómez JM, Pérez-García R, Spsnish Registry of Glomerulonephritis. Frequency of renal pathology in Spain 19941999. Nephrol Dial Transplant 2002;17:1594-602.  Back to cited text no. 16
    
17.
Davison AM. The United Kingdom medical research council’s glomerulonephritis registry. Contrib Nephrol 1985;48:24-35.  Back to cited text no. 17
    
18.
Sung NS, Crowley WF Jr., Genel M, et al. Central challenges facing the national clinical research enterprise. JAMA 2003;289:1278-87.  Back to cited text no. 18
    

Top
Correspondence Address:
Mohammed Al-Homrany
Department of Medicine, Nephrology Division, Aseer Central Hospital, Abha
Saudi Arabia
Login to access the Email id


DOI: 10.4103/1319-2442.261335

PMID: 31249226

Rights and Permissions



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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


 
    Abstract
   Introduction
    Materials and Me...
   Results
   Discussion
   Conclusion
    References
    Article Tables
 

 Article Access Statistics
    Viewed233    
    Printed2    
    Emailed0    
    PDF Downloaded50    
    Comments [Add]    

Recommend this journal