These frequencies are similar to the reported frequencies of nephrotic syndrome as indication for biopsy from registries in other parts of the world [ 2,8,11,13,19 ]. Nephrotic range proteinuria has also been shown to be the most common indication for renal biopsy in a recent study that reviewed the profiles of adults admitted to a nephrology unit in the Free State province of South Africa [ 20 ] and consequently represents the most common clinical presentation of renal diseases worldwide.
Although some registries report AUA as the next common indication for biopsy after the nephrotic syndrome, we noted that patients with no known background medical history were referred late or presented for the first time with moderate to severe renal dysfunction. This pattern of late presentation or late referral was also confirmed in the study of van Rensburg et al. Haematuria was the least common indication for a renal biopsy 0. In a similar study from Egypt [ 19 ], haematuria was also the least frequent indication for a renal biopsy 3. In our patients with idiopathic MCGN, secondary causes were excluded following rigorous investigations; however, we cannot rule out the possibility of genetic predisposition.
Registries from some non-European countries have shown FSGS to occur more frequently or to have a high frequency of occurrence in their population relative to other primary glomerular diseases [ 13 ]. The reason for this is not clear.
Kidney Diseases | Renal Disease | MedlinePlus
However, we think that the declining incidence of all primary glomerular diseases, including FSGS, may be related to the rising frequency of secondary glomerular diseases, especially HIVAN which occurs in significantly greater frequency in the young. The distribution of MGN, however, seems to have followed a recognized worldwide pattern, having a higher frequency in the elderly.
Again, unlike many other registries where primary glomerular diseases dominate, secondary glomerular diseases accounted for a higher percentage This has largely been due to the higher prevalence of biopsies related to infections mainly HIV and those performed to characterize the renal lesions of systemic lupus erythematosus SLE. Overall, LN was the most frequent cause of the nephrotic range proteinuria On the other hand, the high prevalence of LN can be explained by the large population of the Cape coloureds mainly Cape Malays and Indians in Cape Town.
Renal disease in SLE is known to occur more commonly in Asians especially Malaysians, Chinese and Indians than in other populations [ 28 ] and therefore may explain the high prevalence of LN seen in Cape Town. Other secondary glomerular diseases such as amyloidosis, myeloma and vascular nephropathies were more commonly seen in the elderly, in keeping with findings from other registries. Such patients may present with malignant hypertension, neuropsychiatric disturbances and renal failure. We observed that the frequencies and distribution of other diseases classified under the category of vascular diseases were similar to reports from other series.
However, as we do not routinely perform renal biopsies in patients with DN, except when there is doubt about the diagnosis or if we suspected other pathologies, the low frequency of DN may have resulted from this policy.
One limitation of this study may be in our policy of not offering to biopsy patients who are asymptomatic and present only with haematuria. This might have contributed to the low prevalence of IgAN.
How do glomerular diseases interfere with kidney function?
This policy is, however, not unique to our centre as it is generally observed across the entire country. Another limitation may be the high percentage of coloured patients in Cape Town which will not be representative of the demographic distribution in other provinces. The results presented in this study are useful in showing the patterns of renal disease commonly encountered in SSA. Although we do not think that the pattern of secondary glomerular diseases we have observed is completely representative of the whole of South Africa or even SSA given that SLE may be less prevalent in other regions as it is in Cape Town, we however consider that the picture of renal disease caused by HIV may be similar or even worse in other areas with poorer health care facilities.
Whether the declining frequency of primary glomerular disease during the period of our study is due to the rising incidence of infection-related GNs will still need to be confirmed.
Kidney Diseases
Our results should provide further proof of the epidemic of HIV renal disease in SSA and should therefore provide motive for prevention, early detection and aggressive treatment. Finally, we hope that our result will provide the necessary stimulus for starting a more comprehensive renal biopsy registry within South Africa. Oxford University Press is a department of the University of Oxford.
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Membranous Nephropathy
Patterns of renal disease in Cape Town South Africa: Correspondence and offprint requests to: Africans , glomerulonephritis , kidney biopsy. ANOVA for the different ethnic groups: View large Download slide. Annual frequencies of HIV-associated nephropathy — Frequencies of pathologies found for the biopsy indication: Renal biopsy registry from a single centre in Serbia: Survey of the Italian Registry of Renal Biopsies. Frequency of the renal diseases for 7 consecutive years. Epidemiology of renal disease in Romania: The Czech registry of renal biopsies.
Occurrence of renal diseases in the years — The epidemiology and prognosis of glomerulonephritis in Denmark — The changing pattern of glomerulonephritis in Singapore over the past two decades.
Glomerular Diseases
Epidemiologic data of renal diseases from a single unit in China: Changing prevalence of glomerular diseases in Korean adults: Changing incidence of glomerular disease in Olmsted County, Minnesota: An overview on frequency of renal biopsy diagnosis in Brazil: The pathological basis of chronic renal failure in Nigerians.
The profile of adult nephrology patients admitted to the Renal Unit of the Universitas Tertiary Hospital in Bloemfontein, South Africa from to Membranoproliferative glomerulonephritis and cryoglobulinaemic glomerulonephritis. Major-histocompatibility complex extended haplotypes in membranoproliferative glomerulonephritis.
Clinical and pathologic characteristics of focal segmental glomerulosclerosis pathologic variants. Findings from Death Notification.
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More on this topic The changing spectrum of primary glomerular diseases within 15 years: Most kidney diseases attack the nephrons. This damage may leave kidneys unable to remove wastes. Causes can include genetic problems, injuries, or medicines. You have a higher risk of kidney disease if you have diabetes , high blood pressure , or a close family member with kidney disease. Chronic kidney disease damages the nephrons slowly over several years.
Other kidney problems include. Your doctor can do blood and urine tests to check if you have kidney disease.
If your kidneys fail , you will need dialysis or a kidney transplant. Kidney Diseases Also called: Resources Reference Desk Find an Expert. Other kidney problems include Cancer Cysts Stones Infections Your doctor can do blood and urine tests to check if you have kidney disease. Keep Your Kidneys Healthy: