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Saudi Journal of Kidney Diseases and Transplantation
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EDITORIAL Table of Contents   
Year : 2008  |  Volume : 19  |  Issue : 3  |  Page : 346-349
Need for Renal Biopsy Registry in Saudi Arabia

Department of Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia

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Many renal lesions may result in chronic kidney disease if not detected early or treated properly. Glomerulonephritis is considered one of the leading causes of end-stage renal disease. The prevalence of different renal lesions were identified by inconsistent studies. The causes of inconsistencies include lack of unified methods in diagnosing and processing renal biopsies by different pathologists, patients selection's bias for renal biopsy, and the variable policies and protocols adopted by different nephrologists. Establishment of renal biopsy registry may help to surmount these differences. In addition, combined data obtained from renal biopsy renal and replacement therapy registries can help study the long-term outcome of patients with renal diseases.

Keywords: Renal biopsy, Registry

How to cite this article:
Al-Homrany M. Need for Renal Biopsy Registry in Saudi Arabia. Saudi J Kidney Dis Transpl 2008;19:346-9

How to cite this URL:
Al-Homrany M. Need for Renal Biopsy Registry in Saudi Arabia. Saudi J Kidney Dis Transpl [serial online] 2008 [cited 2021 Jun 21];19:346-9. Available from: https://www.sjkdt.org/text.asp?2008/19/3/346/40492

   Introduction Top

The prevalence of renal diseases is high, although true incidence of end stage renal disease (ESRD) is usually underestimated in many countries including Saudi Arabia. [1]

Most of the cases approaching ESRD are labeled either as unknown cause or hyper­tensive nephrosclerosis, [Table - 1]. Many such cases are most likely due to chronic glome­rulonephritis (GN) that is not diagnosed and treated early. Therefore, GN may contribute to high percentage of the causes of chronic kidney diseases (CKD), and can be diagnosed properly by performing renal biopsies, which assist therapy and predict prognosis.

Several retrospective studies about the pat­tern of GN in Saudi Arabia concluded that focal segmental glomerulosclerosis (FSGS) was the predominant lesion (15-36.6%). [3],[4],[5] However, others suggested mesangiocapillary GN as the most commonly found pathological lesion (26.4%-38%). [6],[7] IgA nephropathy, which is a very common disease worldwide, was reported in these studies with variable prevalence (6.5-19%). [3],[4],[5],[6],[7],[8],[9],[10],[11] The prevalence of membranous lesion was reported to be from 2.5%-10.6%. [3],[4],[5],[6],[7],[8],[9],[10],[11] These variations of prevalence of GN lesions were not only observed among different centers but also within the same center reporting different results, [7],[8],[9] [Table - 2].

Most of the studies about prevalence of GN in Saudi Arabia were retrospective, hospital based and biased due to reporting from referral centers not community hospitals. Most renal biopsies in these studies lacked immunoflourescence and electron microscopic examination, reported by different patholo­gists, and did not have uniform indications of kidney biopsies among the different centers.

A better approach should prospective stu­dies of prevalence in the form of a national renal biopsy registry (RBR) for results of renal biopsies. Such system may contribute to better understanding of the types of renal disease in Saudi Arabia. Pathologists should formulate a standard protocol or unified guide­lines for the study of the renal biopsies. Furthermore, nephrologists need to agree on the basis of the indications of kidney biopsy to avoid biased selection of cases.

   Expected advantages of RBR Top

Establishing RBR will be advantageous in several aspects:

  1. To describe the epidemiology of medical renal diseases: incidence, prevalence and trends in epidemiology.
  2. To identify high risk patients, prognostic factors and various complications.
  3. To link with other registries to compare the frequency of some renal diseases.
  4. To serve as a source for clinical inter­ventions
  5. To serve as a source for identifying pa­tients with rare renal diseases for clini­cal investigations.
  6. To serve as a source for single- and multicenter investigations research projects.
  7. To help performing genetic and other basic studies.
  8. To help studying the natural history of various glomerular diseases.
  9. To help developing protocols for preventive medicine.

   The suggested Structure of RBR Top

To develop a well constructed structure for a registry, the supervising team should in­volve members from different health sec­tors and different regions of the kingdom. Both Nephrologists and Pathologists need to be involved. The database is owned by the involved institutes (Nephrologists and Patho­logists). Each institute involved appoints one member to follow the tasks in that institute. The registry need to have a chairman with an executive power and has the respon­sibility for all secretarial work, coordination with representative members, moderation of the team meetings, data management, and preparation of annual reports. Duties of the members include meeting periodically, discu­ssing developments, coordinating data col­lection, solving difficulties, approving annual reports, and deciding on utilization of the registry data.

   Method of data collection Top

One of the important features of deve­loping good quality clinical epidemiological research requires adequate and flexible data­base related to specific diseases. [12] Different registries have develo5ped different methods of data collection. [12],[13],[14],[15] Both paper and elec­tronic based collection of database have ad­vantages and disadvantages. Paper-based data collection can be adopted in the initial stage and with time this can be transferred to electronic data collection depending on the available resources. Standardized paper forms, which is a an easy, low cost, and secure me­thod of data collection, can be filled out and faxed to the head-quarter. [13] Online data col­lection is a faster way with which each repre­sentative of health institute is provided with a password, and data can be uploaded to a designated website using a special software.

Both clinical and pathological data are im­portant to establish good reference to causes, presentation, and prognosis of disease. There­fore, various clinical and laboratory para­meters should be recorded during biopsy pro­cedures such as patient's age, gender, blood pressure, renal function, degree of protei­nuria, and serologic investigations. Patholo­gists reporting renal biopsies from different centers should standardize of the pathologi­cal reports diagnosing different types of renal diseases and utilize all available methods for processing renal tissues such as immuno­flourescence stains and electron microscopy.

Finally, combined data of RBR and data collected by Saudi center for organ trans­plantation (SCOT) on ESRD patients will help health providers plan better for the health services rendered to kidney patients and provide appropriate management in order to prevent ESRD in Saudi Arabia.

   References Top

1.Al-Homrany M, Abolfotoh M. Incidence of treated end-stage renal diseases in Asir region, Southern Saudi Arabia. Saudi J Kidney Dis Transpl 1998;9(4):425-9.  Back to cited text no. 1    
2.Saudi Center for Organ Transplantation 2003. Annual Report.  Back to cited text no. 2    
3.Qunibi W, Al-Sibai MB, Taher S, Akhtar M. Renal disease in Saudi Arabia: A study of 147 renal biopsies. King Faisal Specialist Hospital Journal 1984;4:317-23.  Back to cited text no. 3    
4.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. 4    
5.Mitwalli A, Al Wakeel J, Al Mohaya S, et al. Pattern of glomerular disease in Saudi Arabia. Am J Kidney Dis 1996;27(6):797-802.  Back to cited text no. 5    
6.Alhomrany M. Pattern of renal diseases among adults in Saudi Arabia: A clinico­pathological study. Ethn Dis 1999;9(3):463-7.  Back to cited text no. 6    
7.Huraib S, Abu-Aisha H, Mitwalli A, Mahmood K, Memon N, Sulimani F. The spectrum of renal disease found by kidney biopsies at King Khalid University Hospital. Saudi Kidney Dis Transplant Bull 1990;1: 15-9.  Back to cited text no. 7    
8.Al Wakeel J, Mitwalli A, Tarif N, et al. Spectrum and outcome of primary glomeru­lonephritis. Saudi J Kidney Dis Transpl 2004;15(4):440-6.  Back to cited text no. 8    
9.Mitwalli A, 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. 9    
10.Huraib S, Al Khader A, Shaheen F, 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. 10    
11.Mousa D, Al Hawas F, Al Sulaiman M, Al Khader A. 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. 11    
12.Gesualdo L, Di Palma A, Morrone L, et al. The Italian experience of the national registry of renal biopsies. Kidney Int 2004; 66(3):890-4.  Back to cited text no. 12    
13.Heaf J. The Danish renal biopsy registery. Kidney Int 2004;66(3):895-7.  Back to cited text no. 13    
14.Rivera F, Lopez-Gomez J, Perez-Garcia R; Spanish registry of glomerulonephritis. Fre­quency of renal pathology in Spain for 1994-1999. Nephrol Dial Transplant 2002; 17(9):1594-602.  Back to cited text no. 14    
15.Davidson A. The United Kingdom Medical Research Council's Glomerulonephritis Re­gistry. Contrib Nephrol 1985;48:24-35.  Back to cited text no. 15    

Correspondence Address:
Mohammad Al-Homrany
Department of Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha
Saudi Arabia
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PMID: 18445892

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