Clinicopathological profile of Glomerular diseases at the Kenyatta National hospital

Abstract

Kidneydisease is a worldwide public health problem. Glomerular diseases are the most common cause of end stage renal disease worldwide accounting for 51% of end-stage renal disease. Glomerulardiseases in the tropics differ from those in temperate countries in their epidemiology, aetiologyand natural history. Objective of the study The purpose of this study was to describe the clinical and pathological profile of patients presentingwith glomerular diseases at The Kenyatta National Hospital. Methods A cross-sectional descriptive survey with both retrospective and prospective arms was carried out at The Kenyatta National Hospital. For the retrospective arm, records of patients who had renal biopsies between January 2007 and September 2009 were reviewed. For the prospective arm, new patients aged 14 years and above presenting to the renal clinic between November 2009 and March 2010 with proteinuria of 191dl and above were studied. A targeted history, physical examination, relevant laboratory investigations and a renal biopsy were done. Results In total 193 patients were reviewed (149 in the retrospective arm and 44 in the prospective arm). The mean age was 27.3 ± 12.3 while the male to female ratio was 1.14:1. Nephrotic syndrome was the most common clinical presentation (76.2%). The most common histological lesion was FSGS (30.1%) followed by MN (18.1%), MPGN (15.4%), MCD (14.5%) respectively. Idiopathic GN accounted for most of the glomerular diseases. The secondary causes of glomerular diseases identified included lupus nephritis, human immunodeficiency virus, hepatitis B virus and post-streptococcal infection. Conclusion Consistent with other studies, nephrotic syndrome was the most common clinical presentation. FSGS was the most common histological lesion showing a significant increase in frequency when compared with previous local studies.