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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2012  |  Volume : 23  |  Issue : 5  |  Page : 1065-1067
The change in the spectrum of glomerulonephritis in Egypt over the past decade

1 Department of Internal Medicine, Cairo University, Cairo, Egypt
2 Department of Pathology, Cairo University, Cairo, Egypt

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Date of Web Publication13-Sep-2012

How to cite this article:
Elkhatib M, Elnahed MS, Fadda S, Eldeeb M, Saadi G. The change in the spectrum of glomerulonephritis in Egypt over the past decade. Saudi J Kidney Dis Transpl 2012;23:1065-7

How to cite this URL:
Elkhatib M, Elnahed MS, Fadda S, Eldeeb M, Saadi G. The change in the spectrum of glomerulonephritis in Egypt over the past decade. Saudi J Kidney Dis Transpl [serial online] 2012 [cited 2021 Dec 7];23:1065-7. Available from: https://www.sjkdt.org/text.asp?2012/23/5/1065/100955
To the Editor,

We retrospectively reviewed the pathology reports registry of renal biopsies performed on native kidneys in a single nephrology center in the Kasr eleini Teaching Hospital in Cairo, a major medical institute in Egypt. Paraffin sec­tions were produced and stained with hematoxylin and eosin, periodic acid Schiff and Massontrichrome stains and examined by light microscopy. Whenever necessary, sections were stained with silvermethanamine or congored. However, on many occasions, immunofluorescence was not available. Electron microscopy is not available in our unit. All percutaneous renal biopsies over the year 2009 submitted to the Nephrology Unit in Cairo University were included in this study. The main indications for biopsy included nephrotic syndrome, subnephrotic proteinuria (defined as the presence of 300 mg but less than 3 g of proteins in urine per day), suspected secondary hypertension, impaired kidney functions and hematuria (de­fined as the presence of more tham 2-4 RBCs/ HPF in urine in two separate occasions). Re­ports of 437 biopsies were reviewed and cate­gorized by histological diagnosis.

Primary glomerulonephritis (GN) and secon­dary GN were classified as universally known. Of the patients who underwent biopsies, 89% were under the age of 50 years, 8.5% were bet­ween the age of 50-60 years and 3% were over the age of 50 years. Female patients comprised 48%, while male patients were 52%. Fifty-nine percent presented with hypertension, 46% with increased creatinine, 48% with subnephrotic proteinuria, 27% with nephritic syndrome and 55% with hematuria. Lupus nephritis com­prised 24.7% of all performed renal biopsies in addition to mesangioproliferative 10.9%, focal segmental glomerulosclerosis 6.8%, mesangiocapillary GN 6.7%, acute interstitial nephritis 6.25%, membranous nephropathy 5.4%, crescentic GN 5.4%, chronic interstitial nephritis 4.5%, minimal change disease 3.8%, focal proliferative GN 3.6%, amyloidosis 2.7%, nephrosclerosis 1.13% and inconclusive results com­prised 3.6%.

Biopsies were reviewed and categorized accor­ding to clinical presentation.

  1. Frequency of a histopathological lesion in those who presented with nephrotic syn­drome, the most common GN was lupus nephritis (37.5%), followed by membra­nous GN (12.5%).
  2. Frequency of a histopathological lesion in those who presented with subnephrotic proteinuria, the most common GN, was lupus nephritis (30.4%), followed by mesangioproliferative GN (18.5%).
  3. Frequency of a histopathological lesion in those who presented with suspected secon­dary hypertension, the most common GN was lupus nephritis (34.7%), followed by chronic interstitial nephritis (11.5%).
  4. Frequency of a histopathological lesion in those who presented with impaired renal function, the most common GN was lupus nephritis (32%) and end-stage renal disease (ESRD) (32%), followed by acute inters­titial nephritis (10.3%).
  5. Frequency of a histopathological lesion in those who presented with hematuria: the most common GN was lupus nephritis (37%) and ESRD (32%), followed by mesangioproliferative GN (16.5%).
In comparison with previous analysis of the same Egyptian population done almost ten years ago, [1] the following were noticed: there was a striking increase in the prevalence of lupus nephritis in all sorts of presentation cate­gories. There was also an earlier increase of detection of renal disease in secondary hyper­tensive patients. There is a high percentage of accidentally discovered ESRD referred due to rise in creatinine [Table 1]. This may be ex­plained by the adoption of the attitude to treat patients based on the WHO classification for lupus and the awareness of the importance of renal biopsies to such patients. Perhaps in­creased referral of cases rather than a true in­crease in the number of cases might also con­tribute to our findings; it is the increase in the number of cases of systemic lupus erythematosus (SLE) rather than the increase in detec­tion of cases. [2] However, some also attribute the higher inci­dence of lupus among renal biopsies to more advanced techniques regarding the pathologic lab. [3] Other possibilities might include the emergence of an infectious agent or an environmental pollutant that triggers the immune system to produce antibodies. Several infec­tious agents contribute to the pathogenesis of SLE. Viruses, including Epstein-Barr virus may be important, [4],[5] ultraviolet light [6] and silica dust found in cleaning powders, soil, pottery ma­terials, cement and cigarette smoking may in­crease the risk of developing SLE. [7] Although this study seems to be a local re­gistry because it embraces only a referral cen­ter instead of a multicenter study, the infor­mation it provides is a follow-up over ten years in a university hospital, a major referral center, receiving biopsies from all over the country, not just a local area in Cairo. This data about SLE might become the basis of future research.
Table 1: A comparison between the recent and old study of the patterns of glomerulonephritis.

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   References Top

1.Barsoum RS, Francis MR. Spectrum of Glomerulonephritis in Egypt. Saudi J Kidney Dis Transpl 2000;11:421-9.  Back to cited text no. 1
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2.Lawrence RC, Helmick CG, Arnett FC, et al. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum 1998;42:778-99.  Back to cited text no. 2
3.Danchenko N, Satia JA, Anthony MS. Epide­miology of systemic lupus erythematosus: A comparison of worldwide disease burden. Lupus 2006;15:308-18.  Back to cited text no. 3
4.James JA, Harley JB, Scofield RH. Epstein-Barr virus and systemic lupus erythematosus. Curr Opin Rheumatol 2006;18:462.  Back to cited text no. 4
5.James JA, Kaufman KM, Farris AD, Taylor­Albert E, Lehman TJ, Harley JB. An increased prevalence of Epstein-Barr virus infection in young patients suggests a possible etiology for systemic lupus erythematosus. J Clin Invest 1997;100:3019-26.  Back to cited text no. 5
6.Yung R, Powers D, Johnson K, et al. Mecha­nisms of druginduced lupus. II. T cells over-expressing lymphocyte function-associated antigen 1 become autoreactive and cause a lupuslike disease in syngeneic mice. J Clin Invest 1996;97:2866-7.  Back to cited text no. 6
7.Parks CG, Cooper GS. Occupational exposures and risk of systemic lupus erythematosus. Autoimmunity 2005;38:497-506.  Back to cited text no. 7

Correspondence Address:
Mohamed Elkhatib
Department of Internal Medicine, Cairo University, Cairo
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DOI: 10.4103/1319-2442.100955

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