Saudi Journal of Kidney Diseases and Transplantation

REVIEW ARTICLE
Year
: 2019  |  Volume : 30  |  Issue : 1  |  Page : 15--23

Incidence of pediatric glomerular diseases in Arab world: A systematic review


Nasar Yousuf Alwahaibi, Halima Khalfan Al Issaei, Buthaina Saif Al Dhahli 
 Department of Allied Health Sciences, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman

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

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 19 ];30:15-23
Available from: http://www.sjkdt.org/text.asp?2019/30/1/15/252904


Full Text



 Introduction



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



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



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}

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}

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}

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}

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}

 Discussion



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



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

1The World Bank. World Bank Staff Estimates Based on Age/sex Distributions of United Nations Population Divisions World Population Prospects: 2017 Revision. Available from: https://www.data.worldbank.org /indicator/SP. POP.0014.TO.ZS. [Last accessed 2018 Jun 07].
2Pesce F, Schena FP. Worldwide distribution of glomerular diseases: The role of renal biopsy registries. Nephrol Dial Transplant 2010;25: 334-6.
3Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. BMJ 2009;339:b2535.
4Mattoo TK, Mahmood MA, al-Harbi MS. Nephrotic syndrome in Saudi children clinicopathological study of 150 cases. Pediatr Nephrol 1990;4:517-9.
5Mattoo TK, Al-Sowailem AM. Spectrum of renal pathology in 100 selected children with nephrotic syndrome. Ann Saudi Med 1993;13: 420-2.
6al-Rasheed SA, al-Mugeiren MM, al-Salloum AA, al-Sohaibani MO. Childhood renal diseases in Saudi Arabia. A clinicopathological study of 167 cases. Int Urol Nephrol 1996;28:607-13.
7Al-Sabban E. Spectrum of glomerular disease among children in Saudi Arabia. Saudi J Kidney Dis Transpl 1997;8:285-8.
8Barakat AJ, Atiyeh BA. Renal disease in Lebanese children and adolescents. Findings in 118 consecutive percutaneous renal biopsies. J Med Liban 1998;46:306-8.
9Ghnaimat M, Akash N, El-Lozi M. Kidney biopsy in Jordan: Complications and histopathological findings. Saudi J Kidney Dis Transpl 1999;10:152-6.
10El-Reshaid K, Kapoor MM, Nampoory MR, Madda JP, Jawad N, Johny KV. Glomerulonephritis in children : Experience from the Kuwait renal centers. Med Princ Pract 1999;
118:328-33.
12Kari JA. Changing trends of histopathology in childhood nephrotic syndrome in Western Saudi Arabia. Saudi Med J 2002;23:317-21.
13El-Reshaid W, El-Reshaid K, Kapoor MM, Madda JP. Glomerulopathy in Kuwait: The spectrum over the past 7 years. Ren Fail 2003; 25:619-30.
14Jalalah SM, Jamal AA. Childhood primary glomerular diseases in the Western region of Saudi Arabia. Saudi J Kidney Dis Transpl 2009;20:608-12.
15Karnib HH, Gharavi AG, Aftimos G, et al. A 5-year survey of biopsy proven kidney diseases in Lebanon: Significant variation in prevalence of primary glomerular diseases by age, population structure and consanguinity. Nephrol Dial Transplant 2010;25:3962-9.
16Abdelraheem MB, Ali el-TM, Mohamed RM, et al. Pattern of glomerular diseases in Sudanese children: A clinico-pathological study. Saudi J Kidney Dis Transpl 2010;21:778-83.
17Abdullah LS. Histopathological pattern of pediatric renal diseases: A study from a University Hospital in Western Saudi Arabia. Saudi J Kidney Dis Transpl 2012;23:377-84.
18Kaddah A, Sabry S, Emil E, El-Refaey M. Epidemiology of primary nephrotic syndrome in Egyptian children. J Nephrol 2012;25:732-7.
19Hadidi R, Hadidi M, alDabbas M. Spectrum of biopsy-proven kidney disease in children at a Jordanian Hospital. Saudi J Kidney Dis Transpl 2014;25:680-3.
20Bakr A, Eid R, Sarhan A, Hammad A, et al. Fifteen years of kidney biopsies in children: A single center in Egypt. Saudi J Kidney Dis Transpl 2014;25:1321-7.
21Souilmi FZ, Houssaini TS, Alaoui H, Harmouch T, Atmani S, Hida M, et al. Indications and results of renal biopsy in children: A singlecenter experience from morocco. Saudi J Kidney Dis Transpl 2015;26:810-5.
22Cameron JS. The nephrotic syndrome and its complications. Am J Kidney Dis 1987;10:157-71.
23Yuen LK, Lai WM, Lau SC, Tong PC, Tse KC, Chiu MC. Ten-year review of disease pattern from percutaneous renal biopsy: An experience from a paediatric tertiary renal centre in Hong Kong. Hong Kong Med J 2008;14:348-55.
24Yadav SP, Shah GS, Mishra OP, Baral N. Pattern of renal diseases in children: A developing country experience. Saudi J Kidney Dis Transpl 2016;27:371-6.
25Webb NJ, Lewis MA, Iqbal J, Smart PJ, Lendon M, Postlethwaite RJ, et al. Childhood steroid-sensitive nephrotic syndrome: Does the histology matter? Am J Kidney Dis 1996;27: 484-8.
26Bonilla-Felix M, Parra C, Dajani T, RJ, et al. Changing patterns in the histopathology of idiopathic nephrotic syndrome in children. Kidney Int 1999;55:1885-90.
27Baqi N, Singh A, Balachandra S, et al. The paucity of minimal change disease in adolescents with primary nephrotic syndrome. Pediatr Nephrol 1998;12:105-7.
28Moorani KN, Sherali AR. Histopathological pattern in childhood glomerulonephritis. J Pak Med Assoc 2010;60:1006-9.
29Okpechi IG, Ameh OI, Bello AK, Ronco P, Swanepoel CR, Kengne AP. Epidemiology of histologically proven glomerulonephritis in Africa: A systematic review and meta-analysis. PLoS One 2016;11:e0152203.
30Mbakop A, Youmbissi TJ, Gonsu JD, Chatelanat F, Ngu JL. Renal puncture biopsy in nephrotic syndrome in Cameroonian children, adolescent and adults: Histopathologic profile according to age. Arch Anat Cytol Pathol 1990;38:104-7.
31Pakasa M, Kalengayi MR. Nephrotic syndrome in Zaire. Morphological and aetiological aspects. Tropenmed Parasitol 1984;35:193-5.
32Jiang M, Xiao Z, Rong L, et al. Twenty-eight-year review of childhood renal diseases from renal biopsy data: A single centre in China. Nephrology (Carlton) 2016;21:1003-9.
33Paripović D, Kostić M, Kruščić D, J, et al. Indications and results of renal biopsy in children: A 10-year review from a single center in Serbia. J Nephrol 2012;25:1054-9.
34Printza N, Bosdou J, Pantzaki A, et al. Percutaneous ultrasound-guided renal biopsy in children: A single centre experience. Hippokratia 2011;15:258-61.
35Fidan K, Isik Gonul I, Büyükkaragöz B, Isiyel E, Arinsoy T, Soylemezoglu O. Changing trends in pediatric renal biopsies: Analysis of pediatric renal biopsies in national nephrology registry data. Ren Fail 2016;38:1228-33.
36Yang Y, Zhang Z, Zhuo L, Chen DP, Li WG. The spectrum of biopsy-proven glomerular disease in China: A systematic review. Chin Med J (Engl) 2018;131:731-5.
37Polito MG, de Moura LA, Kirsztajn GM. An overview on frequency of renal biopsy diagnosis in Brazil: Clinical and pathological patterns based on 9,617 native kidney biopsies. Nephrol Dial Transplant 2010;25:490-6.
38Swaminathan S, Leung N, Lager DJ, et al. Changing incidence of glomerular disease in Olmsted county, Minnesota: A 30-year renal biopsy study. Clin J Am Soc Nephrol 2006; 1:483-7.
39Zhang L, Long J, Jiang W, et al. Trends in chronic kidney disease in China. N Engl J Med 2016;375:905-6.
40Alwahaibi NY, Al Issaei HK, Al Dhahli BS. Spectrum of glomerular diseases in Arab countries: A systematic review. Saudi J Kidney Dis Transpl 2018;29:1256-66.