- Email: [email protected]
The spectrum of glomerular diseases in the kingdom of bahrain: An epidemiological study based on renal biopsy interpretation
The Spectrum of Glomerular Diseases in the Kingdom of Bahrain: An Epidemiological Study Based on Renal Biopsy Interpretation A. Al Arrayed, S.M. George, A.K. Malik, S. Al Arrayed, S. Rajagopalan, A. Al Arrayed, S.E. Sharqawi, K.S. Ratnakar, E. Fareed, and F. Al Sabag ABSTRACT Glomerular diseases continue to be the leading cause of end-stage renal disease globally. Hence it is important to recognize the glomerular disease pattern in any given geographical area to understand the pathobiology in the region as well as the incidence and progression of the disorder. A total of 498 renal biopsies were performed on patients with proteinuria, hematuria, and mild to moderate renal impairment during a period of 13 years (between January 1990 and December 2002) at a tertiary care hospital. Primary glomerular disease accounted for two-thirds of the glomerular diseases, which was 44.8% of all renal biopsies. The most common histological lesion was minimal change disease (30%). Focal segmental glomerulosclerosis was the second most common lesion (23.8%) followed by membranoproliferative glomerulonephritis (14.3%). Secondary glomerular disease included 33.6% of glomerular diseases with 22.7% with lupus nephritis as the commonest lesion (38.9%) followed by diabetic nephropathy (31.9%) and hypertension (20.4%). Tubulointerstitial diseases accounted for 13.1% of all renal biopsies, whereas transplant diseases were noted in 12.2%. The miscellaneous group including inadequate biopsies, which constituted 7.2% of all the tissues. The results of this analysis were compared with surveys from other parts of the world.
G
lomerular diseases represent the most common cause of end-stage renal disease in many countries. Its pattern, however, is not uniform in all countries. Glomeruli are affected by a variety of environmental insults and systemic disorders apart from primary causes. All glomerular diseases generally present with a variable spectrum of proteinuria, hematuria, hypertension, or impaired renal function. Moreover, glomerular disease may be indolent, insidiously developing to uremia. Renal biopsy has a fundamental role in the evaluation of proteinuric patients to establish an accurate diagnosis, provide a prognosis, and help in the choice of appropriate treatment. Since there are no data on the pattern of glomerular disease in the Kingdom of Bahrain, a retrospective study was undertaken to analyze glomerular diseases in the Kingdom of Bahrain by reviewing the renal biopsies performed during the 13-year period from January 1990 to December 2002.
MATERIALS AND METHODS Patients referred for diagnosis, treatment, and follow-up from January 1990 to December 2002 underwent 498 renal biopsies,
which retrospectively reviewed to analyze the pattern of glomerular disease. There were 288 men and 210 women of ages ranging from 2 days to 80 years. The demographics of Bahrain reveals a cosmopolitan population with nationals of many foreign countries, especially Asians in the expatriate workforce. The patients’ ethnic origin for the purpose of this study was classified into two categories: Arabs (from Bahrain, UAE, Oman, Yemen, Saudi Arabia, Kuwait, Qatar, North and East Africa, and the Mediterranean region) versus non-Arabs, the majority being Indian or Pakistani. The indications for renal biopsy included proteinuria, unexplained microscopic or macroscopic hematuria with or without active urine sediments, systemic disease with clinical evidence of renal involvement, unexplained renal impairment, and renal impairment in posttransplant patients. All renal tissues were obtained by percutaneous biopsy using a From the Departments of Nephrology (A.A.A., S.A.A., S.R., A.A.A., S.E.S.) and Pathology (S.M.G., A.K.M., K.S.R., E.F., F.A.S.), Salmaniya Medical Complex, Manama, Kingdom of Bahrain. Address reprint requests to Dr Ahmed Al Arrayed, Chairman, Department of Nephrology, Salmaniya Medical Complex, PO Box 12; Manama, Kingdom of Bahrain. [email protected]
0041-1345/04/$–see front matter doi:10.1016/j.transproceed.2004.07.027
© 2004 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710
1792
Transplantation Proceedings, 36, 1792–1795 (2004)
GLOMERULAR DISEASES IN KINGDOM OF BAHRAIN
1793
Table 1. Histopathological Profile of 498 Renal Biopsies With Sex and Nationality Categories
Number of biopsies
Male
Female
Arabs
Non-Arabs
Glomerular disease Tubulointerstitial disease Transplant pathology Miscellaneous Total
336 (67.5%) 65 (13.1%) 61 (12.2%) 36 (7.2%) 498
185 46 32 25 288
151 19 29 11 210
250 44 55 26 375 (75.3%)
86 21 6 10 123 (24.7%)
trucut needle under ultrasound guidance. Three samples were taken from each patient and were processed by light microscopy, immunofluorescence, and electron microscopy. Sections of formalin-fixed paraffin-embedded tissue were stained using haematoxylin-eosin, periodic-acid schiff (PAS) and Jones reagents for light microscopic examination by a histopathologist. The immunofluorescence microscopy panel included IgA, IgM, IgG, C3, C 1q, and fibrinogen. The electron microscopy studies were performed by sending the specimens to overseas laboratories in France or the United Kingdom. The patient data were obtained from the medical records.
RESULTS
Among the 498 renal biopsies, glomerular disease constituted 67.5% of the total. Arabs yielded 75% of this material with a male:female ratio of 1.4:1. The histopathological profile of the renal biopsies and the sex and ethnic distribution are shown in Table 1. Primary glomerular diseases constituted 66.4% of glomerular lesions; secondary glomerular diseases, 33.6% (Table 2). Among the primary glomerular diseases, minimal change disease was the commonest lesion (30%). The second commonest diagnosis was focal segmental glomerulosclerosis (23.8%). The other types of primary glomerular disease, their numbers, age, sex, and ethnic distributions are as shown in Table 3. Lupus nephritis (38.9%) formed the commonest cause of secondary glomerular diseases followed by diabetic nephropathy (31.9%) and hypertensive nephropathy (20.4%). Table 4 shows the histopathological profile along with age, sex, and ethnic distribution of the secondary glomerular diseases. Male patients were more affected than females among the primary glomerular diseases (58.3% vs 41.7%), as clearly seen for FSGS (62.3% vs 37.7%), minimal change disease (67.2% vs 32.8%), and membranous glomerulonephritis (63.3% vs 36.7%). The age of the subjects ranged from 5 weeks to 75 years. Among the secondary glomerular disease, women were more frequently affected (51.3% vs 48.7%) especially with respect to lupus nephritis (75% vs 25%) and Henoch Schonlein purpura; in the latter instance, both cases were
female. Hypertensive and diabetic nephropathy were more common in men. Age who ranged from 10 years to 80 years. DISCUSSION
The literature has only a limited amount of populationbased epidemiological data on the spectrum of biopsyproven glomerular diseases. A review of renal biopsy data may provide some insight into the spectrum of clinically significant renal disease in a community. Our institution receives renal biopsies from the entire island nation of Bahrain with a population of 656,397, which includes 228,424 nonnationals. This report is a national epidemiological study of biopsyproven renal diseases. The rate of biopsy-proven renal diseases underestimates the true incidence of disease, as only those above a certain level of severity are likely to be biopsied. Hence our figures only reflect the incidence of moderate to severe renal diseases. Bahrain has an expatriate population of nearly one-third of the total population. However, they constituted a quarter of the biopsy rates. Primary diseases accounted for two-thirds of the glomerular disorders, which was 44.8% of all renal biopsies. The commonest histological lesion was minimal change disease (30%). Focal segmental glomerulosclerosis was the second most common lesion (23.8%) followed by membranoproliferative glomerulonephritis (14.3%). Secondary diseases included 33.6% of glomerular diseases, constituting 22.7% of all the renal biopsies, with lupus nephritis forming the commonest lesion (38.9%) followed by diabetic nephropathy (31.9%) and hypertension (20.4%). Tubulointerstitial diseases accounted for 13.1% of all renal biopsies, whereas transplant diseases were noted in 12.2%. The miscellaneous group including inadequate biopsies constituted 7.2% of all the biopsies. This study showed that glomerular diseases were more common in males that in females (male:female ratio is 1.2:1). This is similar to other epidemiological studies1– 4 The incidences of renal biopsies in different countries vary. Our incidence of 5.8/100,000 per year is similar to the studies in Spain5 and Macedonia,1 while the report from
Table 2. Categorization of Glomerular Disease in the Renal Biopsies Category
Number of biopsies
M
F
Arabs
Non-Arabs
Primary glomerular diseases Secondary glomerular diseases Total
223 (66.4%) 113 (33.6%) 336
130 55
93 58
159 91
64 22
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AL ARRAYED, GEORGE, MALIK ET AL Table 3. Primary Glomerular Disease in 223 Patients (66.4% of GD; 44.8% of All Biopsies) Type
Number of biopsies
Age range
Male
Female
Arabs
Non-Arabs
MCD FSGS Mesangio proliferative GN Membranous GN MPGN Crescentic GN IgA nephropathy Thin membrane disease Congenital nephrotic syndrome Alports syndrome Sickle cell nephropathy Postinfectious glomerulonephritis Total
67 (30%) 53 (23.8%) 13 (5.8%) 30 (13.5%) 32 (14.3%) 6 (2.7%) 1 (0.4%) 9 (4%) 2 (0.9%) 2 (0.9%) 1 (0.4%) 7 (3.1%) 223 (100%)
7 weeks–67 y 5 weeks–71 y 11–67 y 22–67 y 9–75 y 19–44 y 18 y 27–50 y 4 mo–2 y 9–38 y 40 y 11–42 y
45 33 4 19 16 3 1 3 0 2 0 4 130
22 20 9 11 16 3 0 6 2 0 1 3 93
44 36 10 22 24 4 1 8 2 2 1 5 159
23 17 3 8 8 2 0 1 0 0 0 2 64
Australia2 had a much higher incidence of 21/100,000 per year. An epidemiological study from United Arab Emirates6 reported 490 biopsies over an 18-year period, which is less than our series. These variations may be due to the time span of the reviews and/or because of the various biopsy policies adopted by different centers. In our study glomerular diseases constituted 3.9/100,000 per year, which is 67% of the total renal biopsies. This incidence is similar to the reports from Australia, Denmark, Iran, and Senegal,2,3,7,8 while data from United Arab Emirates and Saudi Arabia4,6 have revealed a higher rate of glomerular diseases. The discrepancy may be due to the fact that the reports from Saudi Arabia and United Arab Emirates studied only native kidney biopsies while our study also included transplant biopsies. The 44.8% rate of primary glomerular diseases among the total renal biopsies in our series was low compared to studies from United Arab Emirates, Iran, Senegal, and Saudi Arabia.4,6 – 8 This could be explained by the high rate of inadequate biopsies (approximately 10%) and inclusion of transplant biopsies. Among the primary glomerular diseases, the various conditions differ in their incidences in various studies. Our study showed a high incidence of minimal change disease and focal segmental glomerulosclerosis (FSGS), while the Saudi Arabia4 study had a high incidence of FSGS and the United Arab Emirates,6 a high incidence of membranoproliferative glomerulonephritis (MPGN),
while selection bias in the single-hospital study from Saudi Arabia may explain how, the cause of the major difference between UAE and our study needs to be explored. Changing incidences of glomerular diseases over time have been found in various communities,9 possibly due to genetic and environmental factors. Vasculitis was not a major cause in any studies from an including our study. However, they form a substantial cohort in the Australian and Spanish studies.2,5 Among the secondary glomerular diseases, lupus nephritis was the commonest condition with a female preponderance, which is consistent with the studies from Spain, Australia, and Arab countries.2,4 – 6,8 In conclusion, there exists a wide variability in the different categories of primary and secondary glomerular diseases in various parts of the world and even within the Arabian Gulf countries. Future studies should be directed to analyze the cause of these variations.
REFERENCES 1. Polenakovic MH, Grcevska L, Dzikova S: The incidence of biopsy-proven primary glomerulonephritis in the Republic of Macedonia—long term follow-up. Nephrology Dialysis and Transplantation 18(Suppl 5):v26, 2003 2. Briganti EM, Dowling J, Finlay M, et al: The incidence of biopsy-proven glomerulonephritis in Australia. Nephrology Dialysis and Transplantation 16:1364, 2001
Table 4. Secondary Glomerular Disease in 113 Patients (33.6% of GD; 22.7% of All biopsies) Type
Lupus nephritis Diabetic nephropathy Hypertension Amyloidosis Good pasture’s syndrome Hemolytic uremic syndrome Henoch Schonlein purpura Scleroderma Total
Number of biopsies
44 (38.9%) 36 (31.9%) 23 (20.4%) 3 (2.7%) 1 (0.9%) 3 (2.7%) 2 (1.8%) 1 (0.9%) 113 (100%)
Age range (years)
Male
Female
Arabs
Non-Arabs
10–55 15–80 23–76 26–45 32 30–35 13–45 42
11 20 19 2 1 1 0 1 55
33 16 4 1 0 2 2 0 58
38 30 16 2 0 3 1 1 91
6 6 7 1 1 0 1 0 22
GLOMERULAR DISEASES IN KINGDOM OF BAHRAIN 3. Heaf J, Lokkegaard H, Larsen S: The epidemiology and prognosis of glomerulonephritis in Denmark 1985–1997. Nephrology Dialysis and Transplantation 14:1889, 1999 4. Mitwalli AH, Al Wakeel JS, Al Mohaya SS, et al: Pattern of glomerular disease in Saudi Arabia. Am J Kidney Dis 27:797, 1996 5. Rivera F, López-Gómez JM, Pérez-Garcı´a R: Frequency of renal pathology in Spain 1994 –1999. Nephrology Dialysis and Transplantation 17:1594, 2002 6. Yahya TM, Pingle A, Boobes Y, et al: Analysis of 490 kidney
1795 biopsies: data from the United Arab Emirates Renal Diseases Registry. Journal of Nephrology 11:148, 1998 7. Antonoovych TT, Sabnis SG, Broumand BB: A study of membranoproliferateive glomerulonephritis in Iran. Annals of Saudi Medicine 19:505, 1999 8. Abdou N, Boucar D, El Hadj Fary KA, et al: Histopathological profiles of nephropathies in Senegal. Saudi J Kidney Dis Transplant 14:212, 2003 9. Braden GL: Changing incidence of glomerular diseases in adults. Am J Kidney Dise 35:878, 2000
G
lomerular diseases represent the most common cause of end-stage renal disease in many countries. Its pattern, however, is not uniform in all countries. Glomeruli are affected by a variety of environmental insults and systemic disorders apart from primary causes. All glomerular diseases generally present with a variable spectrum of proteinuria, hematuria, hypertension, or impaired renal function. Moreover, glomerular disease may be indolent, insidiously developing to uremia. Renal biopsy has a fundamental role in the evaluation of proteinuric patients to establish an accurate diagnosis, provide a prognosis, and help in the choice of appropriate treatment. Since there are no data on the pattern of glomerular disease in the Kingdom of Bahrain, a retrospective study was undertaken to analyze glomerular diseases in the Kingdom of Bahrain by reviewing the renal biopsies performed during the 13-year period from January 1990 to December 2002.
MATERIALS AND METHODS Patients referred for diagnosis, treatment, and follow-up from January 1990 to December 2002 underwent 498 renal biopsies,
which retrospectively reviewed to analyze the pattern of glomerular disease. There were 288 men and 210 women of ages ranging from 2 days to 80 years. The demographics of Bahrain reveals a cosmopolitan population with nationals of many foreign countries, especially Asians in the expatriate workforce. The patients’ ethnic origin for the purpose of this study was classified into two categories: Arabs (from Bahrain, UAE, Oman, Yemen, Saudi Arabia, Kuwait, Qatar, North and East Africa, and the Mediterranean region) versus non-Arabs, the majority being Indian or Pakistani. The indications for renal biopsy included proteinuria, unexplained microscopic or macroscopic hematuria with or without active urine sediments, systemic disease with clinical evidence of renal involvement, unexplained renal impairment, and renal impairment in posttransplant patients. All renal tissues were obtained by percutaneous biopsy using a From the Departments of Nephrology (A.A.A., S.A.A., S.R., A.A.A., S.E.S.) and Pathology (S.M.G., A.K.M., K.S.R., E.F., F.A.S.), Salmaniya Medical Complex, Manama, Kingdom of Bahrain. Address reprint requests to Dr Ahmed Al Arrayed, Chairman, Department of Nephrology, Salmaniya Medical Complex, PO Box 12; Manama, Kingdom of Bahrain. [email protected]
0041-1345/04/$–see front matter doi:10.1016/j.transproceed.2004.07.027
© 2004 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710
1792
Transplantation Proceedings, 36, 1792–1795 (2004)
GLOMERULAR DISEASES IN KINGDOM OF BAHRAIN
1793
Table 1. Histopathological Profile of 498 Renal Biopsies With Sex and Nationality Categories
Number of biopsies
Male
Female
Arabs
Non-Arabs
Glomerular disease Tubulointerstitial disease Transplant pathology Miscellaneous Total
336 (67.5%) 65 (13.1%) 61 (12.2%) 36 (7.2%) 498
185 46 32 25 288
151 19 29 11 210
250 44 55 26 375 (75.3%)
86 21 6 10 123 (24.7%)
trucut needle under ultrasound guidance. Three samples were taken from each patient and were processed by light microscopy, immunofluorescence, and electron microscopy. Sections of formalin-fixed paraffin-embedded tissue were stained using haematoxylin-eosin, periodic-acid schiff (PAS) and Jones reagents for light microscopic examination by a histopathologist. The immunofluorescence microscopy panel included IgA, IgM, IgG, C3, C 1q, and fibrinogen. The electron microscopy studies were performed by sending the specimens to overseas laboratories in France or the United Kingdom. The patient data were obtained from the medical records.
RESULTS
Among the 498 renal biopsies, glomerular disease constituted 67.5% of the total. Arabs yielded 75% of this material with a male:female ratio of 1.4:1. The histopathological profile of the renal biopsies and the sex and ethnic distribution are shown in Table 1. Primary glomerular diseases constituted 66.4% of glomerular lesions; secondary glomerular diseases, 33.6% (Table 2). Among the primary glomerular diseases, minimal change disease was the commonest lesion (30%). The second commonest diagnosis was focal segmental glomerulosclerosis (23.8%). The other types of primary glomerular disease, their numbers, age, sex, and ethnic distributions are as shown in Table 3. Lupus nephritis (38.9%) formed the commonest cause of secondary glomerular diseases followed by diabetic nephropathy (31.9%) and hypertensive nephropathy (20.4%). Table 4 shows the histopathological profile along with age, sex, and ethnic distribution of the secondary glomerular diseases. Male patients were more affected than females among the primary glomerular diseases (58.3% vs 41.7%), as clearly seen for FSGS (62.3% vs 37.7%), minimal change disease (67.2% vs 32.8%), and membranous glomerulonephritis (63.3% vs 36.7%). The age of the subjects ranged from 5 weeks to 75 years. Among the secondary glomerular disease, women were more frequently affected (51.3% vs 48.7%) especially with respect to lupus nephritis (75% vs 25%) and Henoch Schonlein purpura; in the latter instance, both cases were
female. Hypertensive and diabetic nephropathy were more common in men. Age who ranged from 10 years to 80 years. DISCUSSION
The literature has only a limited amount of populationbased epidemiological data on the spectrum of biopsyproven glomerular diseases. A review of renal biopsy data may provide some insight into the spectrum of clinically significant renal disease in a community. Our institution receives renal biopsies from the entire island nation of Bahrain with a population of 656,397, which includes 228,424 nonnationals. This report is a national epidemiological study of biopsyproven renal diseases. The rate of biopsy-proven renal diseases underestimates the true incidence of disease, as only those above a certain level of severity are likely to be biopsied. Hence our figures only reflect the incidence of moderate to severe renal diseases. Bahrain has an expatriate population of nearly one-third of the total population. However, they constituted a quarter of the biopsy rates. Primary diseases accounted for two-thirds of the glomerular disorders, which was 44.8% of all renal biopsies. The commonest histological lesion was minimal change disease (30%). Focal segmental glomerulosclerosis was the second most common lesion (23.8%) followed by membranoproliferative glomerulonephritis (14.3%). Secondary diseases included 33.6% of glomerular diseases, constituting 22.7% of all the renal biopsies, with lupus nephritis forming the commonest lesion (38.9%) followed by diabetic nephropathy (31.9%) and hypertension (20.4%). Tubulointerstitial diseases accounted for 13.1% of all renal biopsies, whereas transplant diseases were noted in 12.2%. The miscellaneous group including inadequate biopsies constituted 7.2% of all the biopsies. This study showed that glomerular diseases were more common in males that in females (male:female ratio is 1.2:1). This is similar to other epidemiological studies1– 4 The incidences of renal biopsies in different countries vary. Our incidence of 5.8/100,000 per year is similar to the studies in Spain5 and Macedonia,1 while the report from
Table 2. Categorization of Glomerular Disease in the Renal Biopsies Category
Number of biopsies
M
F
Arabs
Non-Arabs
Primary glomerular diseases Secondary glomerular diseases Total
223 (66.4%) 113 (33.6%) 336
130 55
93 58
159 91
64 22
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AL ARRAYED, GEORGE, MALIK ET AL Table 3. Primary Glomerular Disease in 223 Patients (66.4% of GD; 44.8% of All Biopsies) Type
Number of biopsies
Age range
Male
Female
Arabs
Non-Arabs
MCD FSGS Mesangio proliferative GN Membranous GN MPGN Crescentic GN IgA nephropathy Thin membrane disease Congenital nephrotic syndrome Alports syndrome Sickle cell nephropathy Postinfectious glomerulonephritis Total
67 (30%) 53 (23.8%) 13 (5.8%) 30 (13.5%) 32 (14.3%) 6 (2.7%) 1 (0.4%) 9 (4%) 2 (0.9%) 2 (0.9%) 1 (0.4%) 7 (3.1%) 223 (100%)
7 weeks–67 y 5 weeks–71 y 11–67 y 22–67 y 9–75 y 19–44 y 18 y 27–50 y 4 mo–2 y 9–38 y 40 y 11–42 y
45 33 4 19 16 3 1 3 0 2 0 4 130
22 20 9 11 16 3 0 6 2 0 1 3 93
44 36 10 22 24 4 1 8 2 2 1 5 159
23 17 3 8 8 2 0 1 0 0 0 2 64
Australia2 had a much higher incidence of 21/100,000 per year. An epidemiological study from United Arab Emirates6 reported 490 biopsies over an 18-year period, which is less than our series. These variations may be due to the time span of the reviews and/or because of the various biopsy policies adopted by different centers. In our study glomerular diseases constituted 3.9/100,000 per year, which is 67% of the total renal biopsies. This incidence is similar to the reports from Australia, Denmark, Iran, and Senegal,2,3,7,8 while data from United Arab Emirates and Saudi Arabia4,6 have revealed a higher rate of glomerular diseases. The discrepancy may be due to the fact that the reports from Saudi Arabia and United Arab Emirates studied only native kidney biopsies while our study also included transplant biopsies. The 44.8% rate of primary glomerular diseases among the total renal biopsies in our series was low compared to studies from United Arab Emirates, Iran, Senegal, and Saudi Arabia.4,6 – 8 This could be explained by the high rate of inadequate biopsies (approximately 10%) and inclusion of transplant biopsies. Among the primary glomerular diseases, the various conditions differ in their incidences in various studies. Our study showed a high incidence of minimal change disease and focal segmental glomerulosclerosis (FSGS), while the Saudi Arabia4 study had a high incidence of FSGS and the United Arab Emirates,6 a high incidence of membranoproliferative glomerulonephritis (MPGN),
while selection bias in the single-hospital study from Saudi Arabia may explain how, the cause of the major difference between UAE and our study needs to be explored. Changing incidences of glomerular diseases over time have been found in various communities,9 possibly due to genetic and environmental factors. Vasculitis was not a major cause in any studies from an including our study. However, they form a substantial cohort in the Australian and Spanish studies.2,5 Among the secondary glomerular diseases, lupus nephritis was the commonest condition with a female preponderance, which is consistent with the studies from Spain, Australia, and Arab countries.2,4 – 6,8 In conclusion, there exists a wide variability in the different categories of primary and secondary glomerular diseases in various parts of the world and even within the Arabian Gulf countries. Future studies should be directed to analyze the cause of these variations.
REFERENCES 1. Polenakovic MH, Grcevska L, Dzikova S: The incidence of biopsy-proven primary glomerulonephritis in the Republic of Macedonia—long term follow-up. Nephrology Dialysis and Transplantation 18(Suppl 5):v26, 2003 2. Briganti EM, Dowling J, Finlay M, et al: The incidence of biopsy-proven glomerulonephritis in Australia. Nephrology Dialysis and Transplantation 16:1364, 2001
Table 4. Secondary Glomerular Disease in 113 Patients (33.6% of GD; 22.7% of All biopsies) Type
Lupus nephritis Diabetic nephropathy Hypertension Amyloidosis Good pasture’s syndrome Hemolytic uremic syndrome Henoch Schonlein purpura Scleroderma Total
Number of biopsies
44 (38.9%) 36 (31.9%) 23 (20.4%) 3 (2.7%) 1 (0.9%) 3 (2.7%) 2 (1.8%) 1 (0.9%) 113 (100%)
Age range (years)
Male
Female
Arabs
Non-Arabs
10–55 15–80 23–76 26–45 32 30–35 13–45 42
11 20 19 2 1 1 0 1 55
33 16 4 1 0 2 2 0 58
38 30 16 2 0 3 1 1 91
6 6 7 1 1 0 1 0 22
GLOMERULAR DISEASES IN KINGDOM OF BAHRAIN 3. Heaf J, Lokkegaard H, Larsen S: The epidemiology and prognosis of glomerulonephritis in Denmark 1985–1997. Nephrology Dialysis and Transplantation 14:1889, 1999 4. Mitwalli AH, Al Wakeel JS, Al Mohaya SS, et al: Pattern of glomerular disease in Saudi Arabia. Am J Kidney Dis 27:797, 1996 5. Rivera F, López-Gómez JM, Pérez-Garcı´a R: Frequency of renal pathology in Spain 1994 –1999. Nephrology Dialysis and Transplantation 17:1594, 2002 6. Yahya TM, Pingle A, Boobes Y, et al: Analysis of 490 kidney
1795 biopsies: data from the United Arab Emirates Renal Diseases Registry. Journal of Nephrology 11:148, 1998 7. Antonoovych TT, Sabnis SG, Broumand BB: A study of membranoproliferateive glomerulonephritis in Iran. Annals of Saudi Medicine 19:505, 1999 8. Abdou N, Boucar D, El Hadj Fary KA, et al: Histopathological profiles of nephropathies in Senegal. Saudi J Kidney Dis Transplant 14:212, 2003 9. Braden GL: Changing incidence of glomerular diseases in adults. Am J Kidney Dise 35:878, 2000