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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2008  |  Volume : 19  |  Issue : 6  |  Page : 997-1000
Spectrum of glomerulonephritis in adult Jordanians at Jordan university hospital


Department of Internal Medicine, Division of Nephrology, University of Jordan, Amman, Jordan

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   Abstract 

We retrospectively reviewed the records and histopathological findings of 64 ade­quate native kidney biopsies performed at the Jordan University Hospital from January 2002 through December 2006. The nephrotic syndrome (NS) was the main reason for biopsy in 51.6% of the cases and deterioration of kidney function in 31%. Primary glomerulonephritis (GN) was diagnosed in 59.4% of the biopsies, and focal segmental glomeulosclerosis (FSGS) was the most common pathology detected (17.2%). Systemic lupus erythematosis was found in 17 patients (26.6%), and it was the commonest secondary GN pathology.

Keywords: Glomerulonephritis, Nephrotic syndrome, Proteinuria, Jordan

How to cite this article:
Wahbeh AM, Ewais MH, Elsharif ME. Spectrum of glomerulonephritis in adult Jordanians at Jordan university hospital. Saudi J Kidney Dis Transpl 2008;19:997-1000

How to cite this URL:
Wahbeh AM, Ewais MH, Elsharif ME. Spectrum of glomerulonephritis in adult Jordanians at Jordan university hospital. Saudi J Kidney Dis Transpl [serial online] 2008 [cited 2020 Nov 27];19:997-1000. Available from: https://www.sjkdt.org/text.asp?2008/19/6/997/43483

   Introduction Top


Glomerulonephritis (GN) remains an impor­tant cause of chronic kidney disease (CKD) and end stage renal disease (ESRD). It has been reported as the commonest cause in Australia and New Zealand, [1] and as the third major cause of kidney disease in Europe and the United States comprising 12.4 and 15.4% of all progressive renal disease, respectively. 1 In Jordan, GN is found to be the second com­mon cause of CKD after diabetes mellitus. [2]

Histopathological diagnosis is the gold stan­dard for the diagnosis of clinically suspected GN. In the present study we report our fin­dings and compare them with previously pub­lished data from Jordan and the neighboring Arab states.


   Subjects and Methods Top


A total of 70 native kidney biopsies were per­formed at the Jordan University Hospital bet­ween January 2002 and December 2006. Biop­sies were done under ultrasound guidance using a spring-loaded biopsy needle. Six biop­sies were excluded because they were either inadequate or had no kidney tissue. The re­maining 64 biopsies were included in the study and reviewed. The biopsies were examined with light microscopy and immunoflorescence, electron microscopy was not available. All pa­tients were subjected to kidney function tests, urine analysis, serum albumin, 24 hour urine collection for protein and workup of secondary causes of GN including ANA, anti-ds-DNA when indicated, C 3 , C 4 , HBV, HCV, HIV, and ANCA. Prior to the biopsy, coagulation stu­dies were run including bleeding time.


   Results Top


Twenty-seven patients were males and the mean age was 31.7 ± 13.2 years. The nephrotic syndrome, nephrotic range proteinuria and per­sistent sub-nephrotic proteinuria was found in 33 (51.6%), 10 (15.6%), and 21 patients (32.8 %), respectively. The mean values of serum albumin, serum creatinine, and 24 hour urine protein were, respectively, 3.02 ± 0.86 gm/dL, 1.48 ± 1.69 mg/dL and 6.12 ± 4.59 gm/24 hrs.

[Table 1] summarizes the frequencies of va­rious pathological findings among the 64 adult renal biopsies. Primary GN was found in 59.4 % of patients while secondary GN was found in 32.8% of the patients. The most common primary pathological findings were, in decrea­sing order, focal segmental glomerulosclerosis (FSGS), mesangioproliferative glomeruloneph­ritis (MesPGN), and membranoproliferative glomerulonephritis (MPGN). Systemic lupus erythematosus, by comparison, was the most common secondary cause of glomerulonephritis.

Comparison of frequencies of GN in males and females shows that FSGS followed by MPGN was the commonest among males, whereas in females the most common GN was lupus nephritis (LN) and MesPGN.

Hematuria occurred in 31 patients and was found in all patients with IgA nephropathy and 54.5% of patients with FSGS. Deterioration of kidney function was mainly observed in pa­tients with systemic lupus, FSGS, and MPGN. Hypertension was associated with MGN, MP­GN, MesPGN, and FSGS. [Table 2] compares the commonly occurring GN.


   Discussion Top


The most common GN in the present study was FSGS followed by MesPGN. This result is in agreement with that reported from Saudi Arabia [3],[4] and Iraq. [5] Considering patients with NS and NRP, the most common causes were FSGS accounting for 27.3% and MPGN accoun­ting for 21.2%, which are again in agreement with those reported from Saudi Arabia [6] and Sudan [7] . This is however different from what has been reported previously from Jordan, [8],[9] where MPGN was the most common cause in 35%, followed by FSGS in 27.1%. Whether the incidence of MPGN is decreasing in Jordan needs further evaluation.

The frequency of occurrence of IgAN recor­ded in the present study is lower than that reported from Saudi Arabia [3],[4] and Jordan [8] but similar to that reported from Sudan [7] and by Huraib et al from Saudi Arabia. [6] This could be due to lower threshold of obtaining biopsies from patients with isolated hematuria or lesser number of patients in our study.

Children were excluded from the study and minimal change disease (MCD) was not diag­nosed in our patient series. This is contrary to the previous reports from Jordan, [8],[9] Saudi Arabia [4],[10] and Bahrain. [11] It is possible that due to lack of electron microscopy, some cases might have been missed and included in cases of MesPGN as reports in the literature. [12],[13]

The prevalence of lupus nephritis was 26.2% which is lower than previous report from Jordan [8] but similar to that reported from Saudi Arabia. [4] The most common type of lupus nep­hritis was stage IV (47%) and this is in agree­ment with that reported from Saudi Arabia, [14] followed by stage V (29.4%). The clinical pre­sentation of LN accounted for NS and NRP in 42.4%, hematuria in (47.1%) and deterioration of kidney function in (29.4%).

In conclusion, our data show that FSGS and MPGN are the commonest cause of NS and NRP in adult Jordanians which is similar to the reports of neighbouring Arab states. Lupus neph­ritis was the commonest cause of secondary GN. There is a need to establish national re­gistry of GN in Jordan and further multi-center studies with larger number of patients are needed to clearly show the various frequencies of GN.

 
   References Top

1.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/New Zealand: Results From an International Comparative Study. Am J Kidney Dis 2000;35(1):57-165.  Back to cited text no. 1    
2.Al-Azzam SI, Abu-Dahoud EY, El-Khatib HA, Dawoud TH, Al-Husein BA. Etiologies of chronic renal failure in Jordanian population. J Nephrol 2007;20(3):336-9.  Back to cited text no. 2    
3.Mousa DH, Al-Hawas FA, Al-Sulaiman MH, Al-Khader A. A prospective study of renal biopsies performed over one year at the Riyadh Armed Forces Hospital. Saudi J Kidney Dis Transplant 2000;11(3):449-54.  Back to cited text no. 3    
4.Mitwalli AH, Al Wakeel J, Abu-Aisha H, et al. Prevalence of glomerular diseases: King Khaled University Hospital, Saudi Arabia. Saudi J Kidney Dis Transpl 2000;11(3):442-8.  Back to cited text no. 4    
5.Shaker IK, Al-Saedi AJ, Al-Salam H, et al. Spectrum of glomerular diseases in Iraqi pa­tients from a single center. Saudi J Kidney Dis Transpl 2002;13(4):515-9.  Back to cited text no. 5    
6.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(3):434-41.  Back to cited text no. 6    
7.Khalifa EH, Kaballo BG, Suleiman SM, Khalil E, El-Hassan A. Pattern of glomerulonephritis in Sudan. Saudi J Kidney Dis Transpl 2004;15 (2):176-9.  Back to cited text no. 7    
8.Said R, Hamzeh Y, Tarawneh M. The spectrum of glomerulopathy in Jordan. Saudi J Kidney Dis Transpl 2000;11(3):430-3.  Back to cited text no. 8    
9.Ghnaimat M, Akash N, El-Lozi M. Kidney biopsy in Jordan: Complications and histo­pathological findings, Saudi J Kidney Dis Transpl 1999;10(2):152-6.  Back to cited text no. 9    
10.Bernieh B, Sirwal IA, Abbadi MA, Ashfaquddin M, Mohammad A. The Spectrum of Glome­rulonephritis in adults in Madinah Munawarah Region. Saudi J Kidney Dis Transpl 2000;11 (3):455-60.  Back to cited text no. 10    
11.Al Arrayed A, George SM, Malik AK, et al. Renal biopsy findings in the kingdom of Bahrain: A 13-year retrospective study. Saudi J Kidney Dis Transpl 2004;15(4):503-7.  Back to cited text no. 11    
12.Saha TC. Singh H. Minimal change disease: A review. South Med J 2006;99(11):1264-70.  Back to cited text no. 12    
13.Tune BM, Mendoza SA. Treatment of the idiopathic nephrotic syndrome: Regimens and outcomes in children and adults. J Am Soc Nephrol 1997;8(5):824-32.  Back to cited text no. 13    
14.Al-Zahrani IH, Qayyum A. Lupus nephritis: Clinicopathological correlation. Saudi Med J 2007;28(10):1503-5.  Back to cited text no. 14    

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Correspondence Address:
Ayman M Wahbeh
Assistant Professor of Medicine, University of Jordan, P.O. Box 1374, Amman 11941
Jordan
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PMID: 18974595

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    Tables

  [Table 1], [Table 2]

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    Abstract
    Introduction
    Subjects and Methods
    Results
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