Year : 2000 | Volume
: 11 | Issue : 3 | Page : 430--433
The Spectrum of Glomerulopathy in Jordan
Riyad Said1, Yousef Hamzeh2, Mesleh Tarawneh3,
1 Department of Medicine, Jordan Hospital, Amman, Jordan
2 Department of Medicine, Jordan University Hospital, Amman, Jordan
3 Department of Pathology, Jordan University Hospital, Amman, Jordan
Department of Medicine, Jordan Hospital, P.O. Box 13132, Amman
In this study, we reviewed the records and the histological findings of a total of 350 adequate native kidney biopsies at both the Jordan University Hospital (260 biopsies in the period 1986-1989) and the Jordan Hospital (90 biopsies in the period 1997-1999). There were 187 males (53.4%) and 163 females (46.6%). Their ages ranged between 12-77 years. The nephrotic syndrome was the presenting feature in 194 (55.4%) patients, acute renal failure in 55 (15.7%), hematuria and/or non-nephrotic proteinuria in 45 (12.9%), chronic renal failure in 32 (9.1%) and hematuria alone 24 (6.9%). In the patients with the nephrotic syndrome, 140 (72.2%) had primary nephrotic syndrome. In this group membranoproliferative glomerulonephritis (MPGN) was the most common pathology and was detected in 49 patients (35%) followed by focal segmental glomerulosclerosis (FSGS) in 38 (27.1%). Amyloidosis and systemic lupus erythematosus were the commonest findings among the 54 patients with secondary nephrotic syndrome (40.7% and 38.8% respectively). Rapidly progressive glomerulonephritis was seen in 34.5% of those patients presenting with acute renal failure, while FSGS was seen in 25% of those with chronic renal failure. Finally IgA nephropathy was the major finding among both the 45 patients with hematuria-proteinuria and the 24 patients with isolated hematuria (26.2% and 66.6% respectively).
|How to cite this article:|
Said R, Hamzeh Y, Tarawneh M. The Spectrum of Glomerulopathy in Jordan.Saudi J Kidney Dis Transpl 2000;11:430-433
|How to cite this URL:|
Said R, Hamzeh Y, Tarawneh M. The Spectrum of Glomerulopathy in Jordan. Saudi J Kidney Dis Transpl [serial online] 2000 [cited 2021 May 5 ];11:430-433
Available from: https://www.sjkdt.org/text.asp?2000/11/3/430/36665
Jordan is an Arab country in the northwestern corner of the Arab peninsula. It has an area of 89,206 sq. kilometers and a population of 4.5 million, with nearly 1.3 million residing in the capital Amman. The major health care providers are the Ministry of Health, the Royal Medical Services, the University Hospital, and recently the private sector. The latter is currently playing a major role in the health care management.
In this report, we will analyze the pattern of glomerular diseases that was seen at both the Jordan University Hospital (500 beds) and the Jordan Hospital, a private hospital with a capacity of 220 beds. In addition, an attempt will be made to compare our data with what has been published previously from Jordan,  the neighboring Arab countries , and international literature. 
Materials and Methods
A total of 350 adequate kidney biopsies were reviewed at both the Jordan University Hospital (260 biopsies in the period between 1986-1989), and the Jordan Hospital (90 biopsies in the period between 1997-1999. For a biopsy to be considered adequate at least six glomeruli were required to be present for evaluation. Biopsies were examined with only light and immunofluorescence microscopy, since electron microscopy was not available for the study.
There were 187 males (53.4%) and 163 females (46.6%), and none of them was a transplant patient. Their ages ranged between 12-77 years; 126 patients (36%) between 12-20 years, 158 (45.1%) between 20-40 years, 50 (14.3%) between 40-60 years and 16 (4.6%) above 60 years.
The nephrotic syndrome was the presenting feature in 194 (55.4%) patients, acute renal failure in 55 (15.7%), hematuria and/or non-nephrotic proteinuria in 45 (12.9%), chronic renal failure in 32 (9.1%) and hematuria alone 24 (6.9%).
In the patients with the nephrotic syndrome, 140 (72.2%) had primary nephrotic syndrome (PNS) while 54 patients (27.8%) had secondary nephrotic syndrome (SNS). Among the patients with PNS, membranoproliferative glomerulonephritis (MPGN) was the most common pathology, being detected in 49 patients (35%) followed by focal segmental glomerulosclerosis (FSGS) in 38 (27.1%), [Table 1]. The renal pathological findings among the SNS patients included amyloidosis of various etiologies that were seen in 22 patients (40.7%) followed by systemic lupus nephritis (SLE) in 21 patients (38.8%), [Table 2].
There were 55 patients (15.7%) who presented with acute renal failure (ARF), [Table 3]. Rapidly progressive glomerulonephritis (RPGN) was the leading cause of ARF and was found in 19 (34.5%) patients. Immune-complex mediated RPGN variety (granular pattern on immuno-fluorescence) was seen in 15 cases; SLE related in four, acute post-streptococcal glomerulonephritis in three, idiopathic type in five, familial Mediterranean fever (FMF) in two and Henoch-Schonlin purpura (HSP) in one.
Anti-neutrophilic cytoplasmic antigen (ANCA) related RPGN was seen in three patients; two had Wegner's granulomatosis, one had polyarteritis nodosa (PAN), and one had anti-glomerular basement membrane antibodies (linear pattern on immunofluorescence).
In the 45 patients (12.5%) who had hematuria/proteinuria as the clinical presentation, the histological findings were distributed as follows. MPGN was found in 10 (22.2%) patients, primary IgA nephropathy in nine (20%), primary mesangioproliferative glomerulonephritis (MsPGN) in eight (17.7%), SLE in seven (15.5%), FSGS in six (13,3%), secondary IgA in three (6.2%) and hereditary nephritis of the Alport's variety in two (4.4%).
The patients who presented with isolated hematuria had either macroscopic (10 cases) or microscopic (14 cases) hematuria. Primary IgA nephropathy was diagnosed in 13 (54%) patients and secondary IgA nephropathy related to FMF in three (12.5%). The rest included seven (29.2%) cases of MsPGN and one case (4.2%) of Alport's syndrome.
Of the 32 patients who presented with chronic renal failure, FSGS and amyloidosis were the leading findings. The rest of causes were of multiple etiologies, [Table 4].
Finally, we looked also into the findings among the elderly group (age between 6077 years). There were 16 patients in this group of whom 11 patients (68.8%) had the nephrotic syndrome. Seven of the nephrotic patients had SNS: four patients with amyloidosis, two with light chain myeloma, one with diabetes mellitus. Four of the elderly nephrotic patients had PNS: three due to membranous nephropathy and one had FSGS. Other findings included ARF in two cases (post infectious glomerulonephritis and acute tubular necrosis), chronic renal failure in two (MPGN and chronic interstitial nephritis) and MsPGN in one case of hematuria and proteinuria.
In this retrospective study which covers the two major referral hospitals in Jordan, only adolescents and adult patients were included. Children less than 12 years were excluded. Accordingly, we had low incidence of MCD (13.6%) among our patients, which is different from what has been published previously. ,,
As far as the indication for kidney biopsies, our findings are in agreement with what has been published previously, indicating that nephrotic syndrome is the major indication for kidney biopsy. ,
The major histological finding among the patients with PNS was MPGN (35%), followed by FSGS (27%). These findings are comparable with a previous publication from Jordan  but different from what has been published from Saudi Arabia. Akhtar  found FSGS in 30.4% of 148 patients, while Huraib  found it in 21.3% of 587 patients and Hass et al  found it in 35% of the patients in their series.
The interesting finding in our study was the high incidence of amyloidosis among the patients with secondary nephrotic syndrome at a percentage of 40.7%. This is a very high prevalence in contrast to what has been published from Saudi Arabia, where both Qunibi  and Akhtar  reported a prevalence rate of amyloidosis of 13.8% and 5.2% respectively. This high prevalence of amyloidosis in our study is attributed to the high prevalence of FMF in Jordan. In fact 45.5% of the amyloid cases were due to FMF.
The prevalence of 9.5% of IgA nephropathy in our study is perhaps marginally higher than the 6.5% IgA nephropathy among the 587 patients with primary GN reported by Huraib et al  from Saudi Arabia of, and the 3% prevalence in Abdurrahman's 300 cases (mostly children) from the same country. 
The prevalence of SLE was 38.8%. This is probably not much different from the report of 44.8% prevalence reported by Qunibi et al  and the 46.7% by Akhtar et al  from Saudi Arabia.
In the acute renal failure group, our findings are in agreement to what has been published previously. 
Finally, the findings among the elderly group (age between 6-77 years) were interesting and not different from a previous publication. 
In conclusion, our data show that MPGN and IgA nephropathy are the commonest types of primary glomerulonephritis in Jordan. At least amyloidosis (mostly FMF) came out as a distinctly common entity of the secondary nephropathies in Jordan, unlike many other Arab countries.
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