Abstract
Background and aimGlomerulonephritis (GN) is a leading cause of end-stage renal disease (ESRD) in Africa. Data on epidemiology and outcomes of glomerular diseases from Africa is still limited. We conducted a systematic review on the epidemiology of histologically proven glomerular diseases in Africa between 1980 and 2014.Materials and methodsWe searched literature using PubMed, AfricaWide, the Cumulative Index to Nursing and Allied Health Literature on EBSCO Host, Scopus, African Journals online databases, and the African Index Medicus, for relevant studies. The review was conducted using standard methods and frameworks using only biopsy-confirmed data.ResultsTwenty four (24) studies comprising 12,093 reported biopsies from 13 countries were included in this analysis. The median number of biopsies per study was 127.0 (50–4436), most of the studies (70.0%) originated from North Africa and the number of performed kidney biopsies varied from 5.2 to 617 biopsies/year. Nephrotic syndrome was the commonest indication of renal biopsy. The frequency of reported primary pathologic patterns included, minimal change disease (MCD); 16.5% (95%CI: 11.2–22.6), focal segmental glomerulosclerosis (FSGS); 15.9% (11.3–21.1), mesangiocapillary GN (MCGN); 11.8% (9.2–14.6), crescentic GN; 2.0% (0.9–3.5) and IgA nephropathy 2.8% (1.3–4.9). Glomerular diseases related to hepatitis B and systemic lupus erythematosus had the highest prevalence among assessed secondary diseases: 8.4% (2.0–18.4) and 7.7% (4.5–11.7) respectively. There was no evidence of publication bias and regional differences were seen mostly for secondary GNs.ConclusionsGlomerular diseases remain poorly characterized in sub-Saharan Africa due to declining renal biopsy rates and consequent paucity of data on pathologic patterns of key renal diseases. Development of renal biopsy registries in Africa is likely to enable adequate characterization of the prevalence and patterns of glomerular diseases; this could have a positive impact on chronic kidney disease evaluation and treatment in the African continent since most glomerulopathies are amenable to treatment.
Highlights
End-stage renal disease (ESRD) is a significant public health issue worldwide, and this problem is compounded by limited access to renal replacement therapy (RRT) in developing countries [1]
Nephrotic syndrome was the commonest indication of renal biopsy
Glomerular diseases related to hepatitis B and systemic lupus erythematosus had the highest prevalence among assessed secondary diseases: 8.4% (2.0–18.4) and 7.7% (4.5–11.7) respectively
Summary
End-stage renal disease (ESRD) is a significant public health issue worldwide, and this problem is compounded by limited access to renal replacement therapy (RRT) in developing countries [1]. With few renal registries in Africa, the patterns of renal diseases are not clearly defined due to limited data stemming from absence of relevant skills and expertise for performing renal biopsies, or appropriate tools and infrastructure to process the biopsy data when available. This creates an important gap about glomerular disease patterns in Africa despite GNs being the commonest cause of ESRD in the continent. We aimed to systematically review available published literature on the epidemiology of histologically proven glomerular diseases in Africa. We conducted a systematic review on the epidemiology of histologically proven glomerular diseases in Africa between 1980 and 2014
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