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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2007  |  Volume : 18  |  Issue : 4  |  Page : 638-642
Kidney Disease in Bahrain: A biopsy based epidemiologic study

1 Department of Nephrology, Salmaniya Medical Complex, Bahrain
2 Department of Pathology, Salmaniya Medical Complex, Bahrain

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The aim of this study was to establish the incidence of renal diseases in Bahrain based on biopsy proven results during the period from January 2003 to October 2006. We studied a total of 145 biopsies obtained from 130 patients; glomerular diseases constituted 64.8%, renal allograft biopsies 23.4%, chronic glomerulosclerosis 8.9%, and others 4.1% of the total. Primary and secondary glomerular diseases were presented equally. The incidence of renal biopsies 5.4/100,000 per year. Minimal change disease­focal segmental glomerulosclerosis (MCD-FSGS) complex was the commonest of all primary glomerular diseases, and lupus nephritis was the commonest secondary glomerulopathy in the biopsied patients. We conclude that there was no significant change in the pattern of glomerulonephritis in Bahrain in comparison with our previous report.

How to cite this article:
Al Arrayed A, Shariff S, Al Maamari MM. Kidney Disease in Bahrain: A biopsy based epidemiologic study. Saudi J Kidney Dis Transpl 2007;18:638-42

How to cite this URL:
Al Arrayed A, Shariff S, Al Maamari MM. Kidney Disease in Bahrain: A biopsy based epidemiologic study. Saudi J Kidney Dis Transpl [serial online] 2007 [cited 2022 Oct 5];18:638-42. Available from: https://www.sjkdt.org/text.asp?2007/18/4/638/36528

   Introduction Top

Epidemiologic studies on renal biopsies are necessary in order to establish the pattern and trends of renal diseases in a particular geographic area. This is important for moni­toring disease trends and to set up policies for early detection and institution of appropriate measures for control of the existing diseases. The first ever report from the Kingdom of Bahrain on the epidemiologic pattern of renal diseases was published in 2004.[1] The study covered a period of 13 years from January 1990 to December 2002 and demonstrated the epidemiologic pattern of renal diseases in the Kingdom of Bahrain.

The current study is a continuation of the previous one and covers the time period from January 2003 to October 2006. We conducted the study to compare incidence and pattern of glomerulonephritis with that previously ob­served data.

   Material and Method Top

We reviewed all renal biopsies, nephrectomy specimens, and referral slides pertaining to renal parenchymal disease in the archives of the Department of Pathology, Salmaniya Medical Complex, Bahrain, from January 2003 to Oct 2006. Cases were categorized into the following groups: a) Glomerular diseases­primary and secondary, b) Tubulo-interstitial disease, c) Transplant pathology, d) Misce­llaneous.

The indications for renal biopsy were proteinuria, macro/microscopic hematuria, nephritic syndrome and/or impaired renal function in non-transplant and renal transplant patients. All biopsies were obtained by a per­cutaneous truecut needle. Three samples were taken and embedded for light microscopy, immunoflurescence and electron microscopy. We examined with light microscopy stained sections; three with Hematoxylin and Eosin, one with periodic acid Schiff, one with Masson's trichrome, and one with Jones silver. Specimens were sent for electron microscopy abroad wherever necessary.

We recorded the patients demographic fea­tures with respect to the age, sex, and nation­nality (Arab and non-Arab). Afterwards, we calculated the incidence of the disease. Incidence for each type of glomerular disease was determined. Comparisons were made with the data obtained from the previous study and from other countries. In diabetic patients, kidney biopsy was only performed if the history and urinalysis were not consistent with the diagnosis of diabetic nephropathy.

   Results Top

We reviewed a total of 145 renal biop­sies from 130 patients. The patients with renal transplants had more than one biopsy each and one case of lupus nephritis had two biopsies. Of the 130 patients 114 (87.6%) were Arabs. Seventy four patients were males and 56 were females with a male to female ratio of 1.31:1. The incidence rate of renal biopsy in the present series is 5.4/100,000 per year.

[Table - 1] shows the list of the diseases found in the study patients in relation to age, sex and ethnic origin. [Table - 2] shows the distri­bution of the various types of primary glo­merular diseases observed during the study period in relation to age, sex and ethnic origin. [Table - 3] shows the distribution of various types of secondary glomerular diseases in relation to the same charac­teristics. [Table - 4] shows the details of the 34 (23.4%) biopsies of the renal allografts that belonged to 23 patients.

Electron microscopy was performed on 20 of the 145 biopsies. It was valuable in confirming the diagnosis in cases of membrane proliferative glomerulonephritis (MPGN), thin membrane disease, congenital nephrotic syndrome, focal segmental glome­rulosclerosis (FSGS) and lupus nephritis.

   Discussion Top

The present population of Bahrain is 698,585. [2] Based on this, the incidence of the renal biopsies was similar to the biopsy rate of 5.8/100,000 per year (38 biopsies per year) observed in our pre­vious study. [1] While this rate of renal biopsies at the Kingdom of Bahrain is higher than that reported in other Middle Eastern countries such as UAE, [3] and Romania [4] (1 per 100,000/year), and equal to incidence in Spain [5] and Macedonia, [6] it is much lower when compared to studies from Australia [7] (21.5 per 100,000 popu­lation), Korea, [8] Hongkong [9] and India. [10] Though biopsy rates may indirectly reflect the prevalence of renal disease in a particular geographic region, it is influenced by several factors such as the population status, biopsy policies of the hospitals, type of hospital (referral or non referral center), and the expertise available at the secondary and tertiary care hospitals.

Glomerular diseases constituted 64.1% of the total biopsies in the present study, while they formed 67.5% of the total biopsies in our series. [1] Chan et al, [9] reported glomerular diseases (primary and secondary) in 73% of the total biopsies, while in Narasimhan [10] reported from India primary glomerular disease alone in 71% of all biopsies .

The primary and secondary glomerular di­seases were observed in almost equal num­bers in the present study, whereas primary glomerular diseases outnumbered the second­dary ones in the previous study (66.4% pri­mary, 33.6% secondary). [1]

Of the primary glomerular diseases the spectrum of MCD-FSGS constituted the highest frequency in the present study as they were in our previous study. However, the incidence of IgA nephropathy observed in the current study was significantly higher than that in our previous study (14.9%, 0.4% respectively). IgA nephropathy is the most common primary nephropathy seen in many series. [7],[9],[11],[12] Better standardization of the detection techniques of the immuno­globulin on biopsy material could have been a contributing factor for the increase in incidence. Secondly, categorization of some of the cases of IgA nephropathy as mesangio-proliferative glomerulonephritis (the most common morphological form of IgA nephropathy) in the former series is a possibility. Furthermore, 10 (21.3%) cases of MPGN were observed in the present study. The percentage observed in our pre­vious study was 14.3%, [1] and in other studies varied from 29.4% [4] to 5.9% [8] to 3.7% [10] of primary GN.

In our current study the pattern of secondary GN remained similar to our previous study. [1] Lupus nephritis was the commonest cause of secondary glomerular disease followed by diabetic nephropathy, and hypertension.

We conclude that there was no significant change in the pattern of glomerulonephritis in Bahrain in comparison with our previous report.

   References Top

1.Al Arrayed A, George SM, Malik AK, et al. The Spectrum of glomerular diseases in the Kingdom of Bahrain: An epidemio­logical study based on renal biopsy inter­pretation. Transplant Proc 2004;36:1792-5.  Back to cited text no. 1    
2.Available from; http://www.countryreports.org/country.aspx? countryID=20&countryName=Bahrain-76k.  Back to cited text no. 2    
3.Yahya TM, Pingle A, Boobes Y, Pingle S. Analysis of 490 kidney biopsies: data from the United Arab Emirates Renal Diseases Registry. J Nephrol 1998;11:148-50.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Covic A, Schiller A, Volovat C, et al. Epidemiology of renal disease in Romania: A 10 year review of two regional renal biopsy data bases. Nephrol Dial Transplant 2006;21:419-24.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Riveria F, Lopez-Gomez JM, Perez-Garcia R. Spanish Registry of Glomerulonephritis. Frequency of renal pathology in Spain 1994-1999. Nephrol Dial Transplant 2002; 17:1594-602.  Back to cited text no. 5    
6.Polenakovic MH, Grcevska L, Dzikova S. The incidence of biopsy proven primary glomerulonephritis in the republic of Macedonia-long term follow up. Nephrol Dial Transplant 2003;18:v26-7.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]
7.Briganti EM, Dowling J, Finlay M, et al. The incidence of biopsy proven glomerulo­nephritis in Australia. Nephrol Dial Transplant 2001;16:1364-7.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]
8.Choi IJ, Jeong HJ, Hans DS, et al. An analysis of 4,514 cases of renal biopsy in Korea. Yonsei Med J 2001;42:247-54.  Back to cited text no. 8    
9.Chan KW, Chan TM, Cheng IK. Clinical and pathological characteristics of patients with glomerular diseases at a university teaching hospital: 5 year prospective review. Hong Kong Med J 1999;5:240-4.  Back to cited text no. 9  [PUBMED]  [FULLTEXT]
10.Narasimhan B, Chacko B, John GT, Korula A, Kirubakaran MG, Jacob CK. Charac­terization of kidney lesions in Indian adults: Towards a renal biopsy registry. J Nephrol 2006;19:205-10.  Back to cited text no. 10  [PUBMED]  [FULLTEXT]
11.Maisonneuve P, Agodoa L, Gellert R, et al. Distribution of primary renal diseases leading to end stage renal failure in the United States, Europe and Australia and New Zealand: Results from an international comparative study. Am J Kidney Dis 2000;35:157-65.  Back to cited text no. 11  [PUBMED]  
12.Schena FP, Cerullo G, Torres DD, et al. The IgA nephropathy Biobank. An important starting point for the genetic dissection of complex trait. BMC Nephrol 2005;6:4. Available from: http://www.biomedcentral.com/1471-2369 /6/14.  Back to cited text no. 12    

Correspondence Address:
Ahmed Al Arrayed
Department of Nephrology, Salmaniya Medical Complex
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Source of Support: None, Conflict of Interest: None

PMID: 17951959

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

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