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RENAL DATA FROM THE ARAB WORLD |
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| Year : 2009 | Volume
: 20
| Issue : 2 | Page : 295-299 |
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| Patterns of primary glomerular diseases among adults in the western region of Saudi Arabia |
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Sawsan M Jalalah
Pathology Department, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
Click here for correspondence address and email
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 Abstract | | |
The frequency of primary glomerular diseases is variable from one part of the world to the other. Data published from Saudi Arabia has shown wide range of variation in the different regions of the country. This study reports the frequency of primary glomerulonephritis (GN) in adults in the Western region of Saudi Arabia. The study is based on retrospective evaluation of archived renal biopsy in the period of 18 years (1989-2007). The 296 selected cases of primary GN were studied by light, immunofluorescence, and electron microscopy. The patients age range between 17-76 years. Results show that the most frequent primary GN is membranous GN (MGN) constituting 25.7%, followed by focal segmental glomerulosclerosis (FSGSC) at 21.3%. Less frequent GN are immunoglobulins A nephropathy (IgAN) representing 17.6%, membranoproliferative GN (MPGN) 11.5%, immunoglobulin M nephropathy (IgMN) 7.8%, minimal change disease (MCD) 5.4% and mesangioprolifertive GN (MesPGN) 4.7%. Other GN which are rarely encountered in this study are fibrillary GN (FGN) (3%), postinfectious GN (PIGN) (2%), Alport syndrome (AS) (0.7%) and membranoproliferative GN type II or dense deposit disease (DDD) (0.3%). In conclusion this study demonstrates that MGN is the most common primary GN encountered in the studied cases, the second more frequent is FSGSC. This result is in contrast to previous reports from Saudi Arabia where MGN is reported with low frequency and FSGSC is reported the most common primary GN. Keywords: Primary Glomerular Disease, Adult, Saudi Arabia
How to cite this article:
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 |
How to cite this URL:
Jalalah SM. Patterns of primary glomerular diseases among adults in the western region of Saudi Arabia. Saudi J Kidney Dis Transpl [serial online] 2009 [cited 2020 Nov 27];20:295-9. Available from: https://www.sjkdt.org/text.asp?2009/20/2/295/45586 |
| Introduction | |  |
The pattern of glomerulonephritis (GN) in Saudi Arabia and in the Arab world is not well documented. Several studies have emerged to report the frequency of glomerulonephritis, however there is no evidence for national epidemiologic studies in the Arab world. [1],[2],[3] Wide range of variation in the frequency of primary glomerular diseases has been shown in the different regions of Saudi Arabia; [4] which might be explained by the difference in the geographic distribution, environmental factors, socioeconomic status, and genetic factors. The current study reports the frequency of primary glomerular diseases in the Western region of Saudi Arabia.
| Patients and Methods | | |
All percutaneous renal biopsy specimens submitted to our hospital and research centre in the period between 1989 and 2007 were reviewed retrospectively, patients or biopsies were referred from different hospitals in the region. The total of 568 adult kidney biopsies were done during this period. Out of these, some cases were excluded due to insufficient tissue, transplant cases, secondary glomerulonephritis, end stage kidney disease, normal glomeruli, tubulointerstitial diseases, and vasculitis [Table 1]. The 296 cases were finally included for analysis in this study the primary diagnosis of glomerular diseases. The group of primary glomerular diseases is analysed and categorized; data is illustrated as frequency and percentages.
All renal biopsies were examined by light microscopy, immunofluoresence and electron microscopy. Renal cortical tissue was divided between the three studies. For light microscopy, tissue submitted is fixed in buffered formalin and routinely processed into paraffin blocks, sections are stained with haematoxylin and eosin (H&E), periodic acid Schiff (PAS), silver methenamine and Masson trichrome. Immunofluoresence was performed on frozen sections labelled with the direct fluorescein isothiocyanate (FITC)-conjugated antibodies against IgG, IgA, IgM, C3, C4, C1q and fibrinogen. For electron microscopy the tissue was fixed in Trump's fixative then routinely processed into resin embedded blocks; ultrathin sections were stained with uranyl acetate and lead citrate and examined with transmission electron microscope Philips CM100.
| Results | | |
The renal biopsies with primary glomerular diseases diagnosed during the last 18 years are retrospectively analysed. There were 296 native renal biopsies identified with primary glomerulonephritis which is the largest group among other renal diseases constituting 52.1%[Table 1]. The patients were adults; age ranging from 17 to 76 years. The frequency of different types of primary glomerulonephritis is illustrated in [Table 2]. The most frequent glomerulonephritis was membranous GN representing 25.7% of the cases, followed by focal segmental glomerulosclerosis. IgA Nephropathy and MPGN ranked next but their frequency was not close to MGN or FSGSC. Lower frequencies were observed for minimal change disease, mesangioprloifrtaive disorder and IgMN; FGN, and PIGN were less frequent. A very low frequency was observed for Alport syndrome and dense deposit disease. The female to male ratio was 1:1.2; the gender distribution for each primary GN separately is illustrated in [Table 3].
| Discussion | | |
This study examines the frequency of primary glomerulonephritis (GN) in adult population in a single centre study in the Western region of Saudi Arabia. The results demonstrated that membranous glomerulonephritis is the most common primary GN in adults constituting 25.7% which is closely followed by focal segmental glomerulosclerosis at 21.3%.
The high frequency of MGN reported in this study has not been reported in any other series from Saudi Arabia. [4],[5],[6],[7],[8],[9] However similar results with high MGN frequency are demonstrated in a study from Iran where MGN constituted 23.6% and it was the most common primary GN in their adult study population as well. [10]
The frequency of FSGSC in the present study is close to that reported in a study from Saudi Arabia by Huraib et al. [8] Other studies reported FSGSC as the most common primary GN in adults mostly in reports from Riyadh the central region of Saudi Arabia [5],[6],[11] and in one study from Dhahran the Eastern part of Saudi Arabia. [9] FSGSC seems to have variable high frequencies in different parts of Saudi Arabia; and the lowest is reported in Asir the South Western region. [7]
MPGN in the current study represents only 11.5% of all primary glomerular diseases, similar low frequency for MPGN are reported in Riyadh, [12] and much lower frequencies for MPGN have also been reported in Saudi population at 2-3%. [5],[6] Whereas the study from Asir in the South Western region reported MPGN as the most common primary GN in adults representing 25.9%. [7]
IgA nephropathy reported in this study constituted 17.6%, third most common GN. Similarly, most studies from different regions of Saudi Arabia reported lower frequencies for IgAN ranging from 6-17%. [5],[6],[7],[8],[9],[12] These results indicates that IgAN is not a common primary GN in Saudi Arabia, and apparently it is not common in the neighbouring countries such as Bahrain [13] and Iran. [10] This is in contrast to the higher frequencies of IgAN in studies from Europe, [14],[15] North America, [16] South America [17] and Far East. [18],[19]
IgM nephropathy has not been reported in adults in the reports from Saudi Arabia, this study reports the frequency of IgMN around 7.8% even higher than MCD 5.4%. It is obvious there are wide variations in the occurrence of primary GN in the different regions of Saudi Arabia which is also different from other parts of the world. Geographic and ethnic factors may be responsible for these variations. Studies show that the frequency of primary GN is different among different ethnic groups. It has been demonstrated that FSGSC is more prevalent in blacks; [20],[21] and MGN is more common in white patients. [21] Unfortunately studies arising from Saudi Arabia (including this study) do not make the distinction of disease occurrence in relation to different ethnic groups as ethnicity is not documented as part of the patient data.
The Western region of Saudi Arabia, especially the regions of the holy cities, Makkah and Madinah, is known to have a heterogeneous population with mixed ethnicity due to the settled pilgrims. Since genetics plays a role in the disease occurrence, ethnicity should be addressed in clinical reports and demographic data collection.
In conclusion the spectrum of primary GN is different in the different regions of Saudi Arabia. The current study is the only study from the Western region of Saudi Arabia that reports high frequency of MGN among primary GN in adults. For better understating of the aetiology and the factors influencing the disease occurrence, the difference in the pattern in the different regions of Saudi Arabia should be acknowledged and correlation with ethnic groups should be documented. This can be achieved efficiently by conducting a larger population study through the national registry for renal diseases.
| References | | |
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Correspondence Address:
Sawsan M Jalalah
Pathology Department, College of Medicine, King Abdulaziz University, P.O. Box 512, Jeddah, 21421
Saudi Arabia
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PMID: 19237826 
[Table 1], [Table 2], [Table 3] |
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