Year : 2009 | Volume
: 20 | Issue : 4 | Page : 608--612
Childhood primary glomerular diseases in the western region of Saudi Arabia
Sawsan M Jalalah, Awatif A Jamal
Pathology Department, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
Sawsan M Jalalah
Pathology Department, College of Medicine, King Abdulaziz University Jeddah
We report our institute experience on primary glomerular disease in children in the western region of Saudi Arabia over the last 18 years (1988 to 2006). A total of 169 cases were identified as primary glomerular diseases in children and adolescent with age range from first year of life till 18 years. Minimal change disease and focal segmental glomerulosclerosis were the commonly encountered primary glomerular diseases (20.1%and 19.5% respectively), mesangioproliferative glomerulonephritis IgM nephropathy (14.8%), IgA nephropathy (10.7%), postinfectious glomerulonephritis (9.5%), membranous glomerulonephritis (7.1%), membranoproliferative glomerulonephritis (5.9%) and mesangioproliferative glomerulonephritis with negative immunofluorescence (5.9%). The less frequently encountered primary glomerular diseases were congenital nephritic syndrome Finnish type (2.4%), Alport syndrome (2.4%), dense deposit disease (1.2%), and mesangioproliferative glomerulonephritis with IgG positive (0.6%). We concluded that minimal change disease and focal segmental glomerulosclerosis are the most common primary glomerular disorder encountered in children in our series and with similar age distribution.
|How to cite this article:|
Jalalah SM, Jamal AA. Childhood primary glomerular diseases in the western region of Saudi Arabia.Saudi J Kidney Dis Transpl 2009;20:608-612
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Jalalah SM, Jamal AA. Childhood primary glomerular diseases in the western region of Saudi Arabia. Saudi J Kidney Dis Transpl [serial online] 2009 [cited 2022 Nov 28 ];20:608-612
Available from: https://www.sjkdt.org/text.asp?2009/20/4/608/53249
Glomerular diseases in the gulf region and in the Middle East are generally not well documented; moreover fewer studies are focused on children. ,,,
Reports have emerged in the last two decades describing the pattern of glomerular diseases in Saudi Arabia, with some similarities and discrepancies in their results. ,,
This study presents the experience of our institute which provides care to centers in the western region of Saudi Arabia. We report the frequency of the primary glomerular diseases in children and adolescents in the western region to contribute for better understanding of the pathogenesis of glomerulonephritis in our region.
Subjects and Methods
A total of 632 percutaneous renal biopsies in the period of 1988 to 2006, at our institute were reviewed retrospectively. Patients' demographic data, age and gender, were collected from the hospital charts. The histopathology, immunofluorescence and electron microscopy findings were evaluated.
Out of the 632 biopsies, a total of 242 cases were children and adolescent with age range from first year of life till 18 years old. Of these 242 renal biopsies only 169 cases were identified as primary glomerular diseases, thereafter analyzed and classified in this study.
The remaining cases were not included in the analysis for the following reasons: end stage kidney disease (7 cases), the biopsy is insufficient (11 cases), and if the diagnosis is secondary glomerulopathy (51 cases), or non glomerular diseases (2 cases) and 2 transplant cases.
The renal cortical tissue obtained in these cases was processed for light microscopy, electron microscopy examination and frozen renal tissue sections are immunolabelled with FITC-conjugated antibodies against (IgG, IgA, IgM, C3, C4, C1q, Kappa, Lambda and fibrinogen).
The patients identified with primary glomerular diseases (n= 169); their age range was between 1-18 year; 94 were male and 71 female.
The frequency of primary glomerular diseases is demonstrated in [Table 1]. Minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGSC) were the most frequently diagnosed conditions 34 cases and 33 cases respectively. Other diagnoses are mentioned in the [Table 1] and [Table 2]. The least frequent primary glomerular diseases included congenital nephrotic syndrome Finnish type (FN) 4 cases and hereditary nephritis Alport syndrome (AS) 4 cases.
Primary glomerular diseases affected males more frequently than females with a ratio of 1.3: 1 [Figure 1]. The male predominance was observed more in MCD, IgA nephropathy (IgAN), Membranous Glomerulonephritis (MGN), Membranoproliferative Glomerulonephritis Type I (MPGNI) and Post Infectious Glomerulonephritis (PIGN), moreover Alport syndrome (AS) cases were all male. On the other hand female predominance was noted in cases of IgM Nephropathy (IgMN) and FSGSC. Equal male and female distribution was noted among FN and idiopathic mesangioproliferative GN (MesPGN).
The age at presentation of the primary glomerular diseases varied from one entity to the other [Table 2]. MCD and FSGSC both frequently presented early in age of 4-6 years. MGN affeced older age group (16-18 years). IgMN had two peaks of occurrence one at age 1-6 years and the second peak at age 16-18 years. Similarly PIGN had two peaks one at age 10-12 years and the second at age 16-18 years. IgAN showed an evenly distribution over all age groups with a minor peak at the age of 10-12 years.
Previous reports reveal the differences and similarities in the pattern of primary glomerular disease distribution from one part of the world to the other. Among the reports published in the literature from the Middle East and the Arab peninsula ,,,,,,,,,,, some are concerned with the childhood glomerular diseases. ,,,, ,,,
The present study confirms that the primary glomerular diseases in children in the western region of Saudi Arabia are more frequent than secondary glomerulopathy representing a ratio of 3.3:1. Furthermore, the study illustrates that MCD and FSGSC are the most common diagnosed entities occurring with almost equal frequency, 19.5% 20% respectively. This is similar to the report by Al-Rasheed et al,  from western region of Saudi Arabia. In contrary to this Sipiczki et al, in their study from Hungary, reported MCD as the most common primary glomerular disease in children. 
On the other hand, FSGSC was found to be twice as common than MCD in the Iranian experience.  This has also been documented in reports from Saudi Arabia.  ,
The discrepancy of the reported frequencies of MCD and FSGSC from one series to the other could be related to renal biopsy policy, sample size or the geographic region and the nature of disease distribution. For centers where biopsy is performed only in children who are steroid resistant or steroid dependent this results in less frequent number of MCD patients undergoing renal biopsy. Therefore MCD is probably under represented in most of the series; resulting in the observed relative increase in the diagnosis of FSGSC among the submitted biopsies. A wider epidemiologic population studies will determine the actual glomerular disease frequency and its geographic distribution and hence will eliminate this bias in the analyzed submitted biopsies to the academic centers. Furthermore inclusion of children with nephrotic syndrome responding to therapy, thus suggesting MCD, will probably represent the actual frequency of MCD vs FSGSC.
IgMN was the third frequent diagnosis occurring in 14.8% of biopsies in our children. This is a higher number reported among our patients since IgMN is not as common and few series reported it as a distinct diagnosis in their series 14; and others have reported the frequency of MesPGN without distinction.  ,
MPGN, on the other hand, has a low frequency, 7.1%, mainly type I. The frequency of MPGN among children with glomerular diseases in Saudi Arabia varies widely from as high as 30% in the study by Kari  to complete absence in another study. 
IgAN in our study represents 10.7% similar to reports from other parts of the world, however higher than the locally reported 3% by Al Ras heed.  , ,
The frequency of MGN in our patients was 12% which is higher than reported by others.  ,
Absence of thin basement membrane diseases (TBMD) in our study compared to others  , is probably the result of avoiding biopsy in microscopic hematuria patients with no other abnormalities.
Our study presents the frequency of primary glomerular diseases in children, the experience gained from the University hospital which is a referral and consultation center in the western region of Saudi Arabia.
In conclusion, the results demonstrated that the most frequently diagnosed primary glomerular disorder among biopsied cases in our series was MCD and FSGSC. Furthermore we suggest that the discrepancies in the reported frequencies of glomerular diseases seen in studies from different centers are affected by the biopsy policy in these centers and may not necessarily reflect the actual occurrence of the disease. Therefore these facts should be taken into consideration when comparison of data from different sources is performed. Finally, it is important to highlight the need for collaborative epidemiologic studies in our region to better understand and provide health care for the glomerular diseases especially in children where data is lacking.
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