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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR  
Year : 2015  |  Volume : 26  |  Issue : 2  |  Page : 375-377
Age and gender distribution of primary and secondary glomerulonephritis obtained by renal biopsy: A study from Hamadan, a great province in Western Iran


Department of Pathology, Hamadan University of Medical Sciences, Hamadan, Iran

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Date of Web Publication3-Mar-2015
 

How to cite this article:
Jafari M, Monsef A, Soleimani B. Age and gender distribution of primary and secondary glomerulonephritis obtained by renal biopsy: A study from Hamadan, a great province in Western Iran. Saudi J Kidney Dis Transpl 2015;26:375-7

How to cite this URL:
Jafari M, Monsef A, Soleimani B. Age and gender distribution of primary and secondary glomerulonephritis obtained by renal biopsy: A study from Hamadan, a great province in Western Iran. Saudi J Kidney Dis Transpl [serial online] 2015 [cited 2021 May 18];26:375-7. Available from: https://www.sjkdt.org/text.asp?2015/26/2/375/152542
To the Editor,

Renal biopsy is an irreplaceable diagnostic tool in determining the diagnosis, prognosis and different treatment options of renal diseases. [1] Collection of epidemiologic data relating to specific renal diseases obtained by renal biopsies has been identified as the key feature for developing quality clinical and epidemiological investigations. On the other hand, developing a national registry has given the opportunity to learn about the epidemiological aspects of renal disorders, especially glomerulonephritis (GN). [2] Because the available data of renal diseases is mainly population based, these data can be widely variable in term of geographic regions, socioeconomic status and ethnicity. In addition, indications for biopsy, genetic variants and history of exposure to environmental factors affecting susceptibility to renal disorders can be major components of databanks specific to renal abnormalities. [3],[4] Several renal biopsy registries exist worldwide; only a small proportion of them are national registries that include the entire population of one country. [5],[6] The goal of the present study is to present the relative frequency of occurrence of GN, obtained by renal biopsy, according to gender and age variables, aiming to facilitate providing a country-based registry in Iran.

In a cross-sectional study, recorded data on 130 needle renal biopsies with the final diagnosis of GN collected at the Ekbatan Hospital during the years 2007-2009 were reviewed. The baseline data considered in the present study included gender, age, histological study used [immunofluorescence (IF) microscopy and light microscopy (LM)], type of GN and its origin as primary or secondary. Data of renal biopsies that could not be adequately classified due to inadequate data entry or inadequate biopsy tissue were excluded from the present analysis. For each patient, a renal needle biopsy sample was sent in 10% formalin for LM and another sample was sent for IF microscopy. Specific staining of Periodic acid-Schiff (PAS) and trichrome in addition to hematoxylin and eosin (H and E) staining were used for all renal biopsies and, in some special cases, Jones and amyloid staining were also applied. IF assessment was made using the markers fibrinogen, C3C, IgG, IgA, IgM, C4C, C1q, kappa and lambda.

Renal biopsies from 130 subjects (55% male and 45% female) with a mean age of 32.98 years (range 2-77 years) were studied. Of all the studied biopsies, primary GN (PGN) was diagnosed in 78% and secondary GN (SGN) in 22% of the samples. Of the 101 patients with PGN, 28 were diagnosed to have membranous GN (MGN), 22 had membranoproliferative GN (MPGN), 14 had immunoglobulin A nephropathy (IgAN), 11 had minimal change disease (MCD) and nine had chronic GN (CGN). Less frequently, rapidly progressive GN (RPGN) was seen in five cases, mesangial proliferative GN in two cases and congenital GN in one case. The main diagnoses in the category of SGN included lupus nephritis (LN) in 25 cases, amyloidosis in two cases and diabetic sclerosis in two other cases. The most frequent type of GN was MGN (21.5%), followed by LN (19.2%) and MPGN (17.0%).

The most common histological variety of PGN was MGN (27.7%), followed by MPGN (21.8%) and IgAN (13.9%) and, in SGN, the most common variety was LN (86.2%). In females, the most common PGN was MGN (35.3%) and in males, the most common PGN was MGN and MPGN (23.5% each). Also, the most prevalent SGN in males and females was LN, with an overall prevalence of 91.6% and 60.0%, respectively. In addition, MGN, LN, MPGN and IgAN were the most frequent types of GN in adults, while MPGN, MCD and PSGN were seen more commonly in children.

Little is known about the variation in incidence of GN, both primary and secondary forms, in our region. The objective of this study was to determine the incidence of GN in Hamadan, a great province in Western Iran. According to our survey, PGN was seen more frequently than SGN. A large study including different countries in Europe, North and South America, Canada, Australasia and the Middle East showed an annual incidence of 0.2/ 100,000 per year for MPGN, 0.2/100,000 per year for MSGN, 0.6/100,000 per year for MCD, 0.8/100,000 per year for focal and segmental glomerulosclerosis (FSGS), 1.2/100,000 per year for MGN and 2.5/100,000 per year for IgAN. [7],[8] In our survey, we found no discrepancy in the incidence of both PGN and SGN between males and females, and the common varieties of PGN and SGN in both genders were MGN and LN, respectively. However, the distribution of these types of GNs was different in children and adults, with a higher incidence of MGN in adults and MPGN in children. In a study by Briganti et al, the most common GNs in adults were IgAN, FSGS, LN and vasculitis and, in children, it was LN, FSGS, IgAN and MCD. Also, they showed a male predominance for all varieties of GN, except LN, in both adults and children. [9] In comparison with the published reports from other regions of our country, the distribution of the types of GN was different compared with our region. In a similar study by Mohammadhoseiniakbari et al, although the overall incidence of PGN and SGN was comparable to our observation (70.2% and 20.6%, respectively), the most common GN was FSGS (37.1%) followed by MGN (16.5%) and LN (13.4%). Furthermore, FSGS was the most common GN in males and in all age-groups. [10] In a retrospective cross-sectional study by Naini et al, based on the analysis of adult renal biopsies in Tehran, 57.8% were males and 42.2% were females. They reported that MGN was the most common GN (23.6%), followed by IgAN (13.5%), MPGN (11.5%), LN (10.6%), FSGS (10.3%) and MCD (9.8%). [11]

Our survey shows that the incidence of GN in the two genders as well as in the age subgroups of our population was different compared with other countries. Also, the incidence of these renal diseases was discrepant in comparison with other areas in our country. Thus, a multi-center study with a larger sample size should be performed in Iran considering different regions and various ethnicities to create a correct Iranian registry of renal biopsies.


   Acknowledgment Top


This study was supported by the Hamadan University of Medical Sciences. We thank the university authorities who offered critical administrative support and managerial services in carrying out the study and also all researchers for their help and support.

Conflict of Interest: None declared.

 
   References Top

1.
Fuiano G, Mazza G, Comi N, et al. Current indications for renal biopsy: A questionnaire-based survey. Am J Kidney Dis 2000;35:448-57.  Back to cited text no. 1
    
2.
Sung NS, Crowley WF Jr, Genel M, et al. Central challenges facing the national clinical research enterprise. JAMA 2003;289:1278-87.  Back to cited text no. 2
    
3.
Choi IJ, Jeong HJ, Han 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. 3
    
4.
Kitiyakara C, Kopp JB, Eggers P. Trends in the epidemiology of focal segmental glomerulosclerosis. Semin Nephrol 2003;23:172-82.  Back to cited text no. 4
    
5.
Rivera F, Lopez-Gomez JM, Perez-Garcia R. Clinicopathologic correlation of renal pathology in Spain. Kidney Int 2004;66:898-904.  Back to cited text no. 5
    
6.
Heaf J. The Danish renal biopsy register. Kidney Int 2004;66:895-7.  Back to cited text no. 6
    
7.
McGrogan A, Franssen CF, de Vries CS. The incidence of primary glomerulonephritis worldwide: A systematic review of the literature. Nephrol Dial Transplant 2011;26: 414-30.  Back to cited text no. 7
    
8.
Coppo R, Gianoglio B, Porcellini MG, Maringihi S. Frequency of renal diseases and clinical indications for renal biopsy in children (Report of the Italian National Registry of Renal Biopsies in Children. Nephrol Dial Transplant 1998;13:294-7.  Back to cited text no. 8
    
9.
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. 9
    
10.
Mohammadhoseiniakbari H, Rezaei N, Rezaei A, Roshan SK, Honarbakhsh Y. Pattern of glomerulonephritis in Iran: A preliminary study and brief review. Med Sci Monit 2009;15:109-14.  Back to cited text no. 10
    
11.
Naini AE, Harandi AA, Ossareh S, Ghods A, Bastani B. Prevalence and clinical findings of biopsy-proven glomerulonephritidis in Iran. Saudi J Kidney Dis Transpl 2007;18:556-64.  Back to cited text no. 11
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Correspondence Address:
Dr. Mohammad Jafari
Department of Pathology, Hamadan University of Medical Sciences, Hamadan
Iran
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DOI: 10.4103/1319-2442.152542

PMID: 25758896

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