Rapidly progressive glomerulonephritis in a tertiary health facility in northeastern Nigeria: Challenges in diagnosis and management

Abstract

Background Rapidly progressive glomerulonephritis (RPGN) is a syndrome that is characterized by the rapid decline of kidney function associated with proteinuria and hematuria and often leads to irreversible kidney failure if diagnosis and subsequent institution of appropriate treatment are not made early. It is thought to be rare in Africa due to late presentation and/or diagnosis of the condition, resulting in many of them labeled as chronic glomerulonephritis. This study aims to determine the prevalence of RPGN among patients admitted with kidney disease in a tertiary health facility in northeastern Nigeria. Patients and methods This cross-sectional hospital-based study was conducted at the University of Maiduguri Teaching Hospital, Maiduguri, Northeast Nigeria, between the periods January 2020 and December 2021. Included in the study were patients admitted into the renal unit who had features of rapidly deteriorating kidney function, normal-sized kidneys more than 8.5 cm, proteinuria, and/or hematuria. Kidney biopsy was done for consenting patients who had normal kidney sizes. The biopsy specimen was fixed in formalin, cut, and stained using hematoxylin and eosin stain. Results A total of 1440 patients were admitted into the renal unit of University of Maiduguri Teaching Hospital, out of whom 28 (1.9%) were diagnosed with RPGN. The ages of the study participants ranged from 17 to 40 years and had a mean of 31.14 ± 7.81 years. Their mean serum creatinine was 1203 ± 495.78 µmol/l and urea 32.67 ± 12.58 moml/l. Proteinuria was present in all patients with RPGN, whereas hematuria was seen in 78.6%. Kidney biopsy was done in 42.9% of patients, 83.3% of them had crescents in more than 50% of glomeruli. Antineutrophil cytoplasmic antibody, complements C3 and C4 were not assayed in any of the study participants. Conclusion RPGN contributes to the burden of kidney disease in northeastern Nigeria. Due to lack of proper investigative tools in our institution, many patients are not diagnosed and those who were identified are not adequately characterized.