Patterns of Glomerular Disease at a Large Urban Public Hospital in South Africa- Impact of HIV Infection

Abstract

Abstract Introduction Glomerular disease is an important cause of renal failure. We sought to describe the patterns of glomerular disease in patients undergoing native kidney biopsy at a large urban public hospital in South Africa during the period 2001–2010. Methods We retrospectively reviewed all native kidney biopsies undertaken during the study period. We further characterised and compared clinical, laboratory and demographic data between glomerular pathologies. Results The majority of patients undergoing biopsy were young (median age 34 years) and of Black African descent (83%). Proteinuria was the most common indication for biopsy. Secondary glomerular disease was more common than primary glomerular disease. HIV-associated glomerular diseases were the most common secondary glomerulopathies Focal segmental glomerulosclerosis (FSGS) was the most frequent primary glomerulopathy. Minimal change nephropathy (MCN) was more frequent in younger patients and membranous nephropathy (MN) more common in older patients. Renal function was poorer in FSGS and membranoproliferative glomerular disease. Conclusions HIV is an important contributor to the high rates of secondary glomerular disease. Primary glomerulopathy demonstrates geographic variation in South Africa with FSGS being dominant in Johannesburg. Although clinical parameters may suggest underlying glomerulopathy, an accurate diagnosis to facilitate directed treatment and prevent progression to renal failure requires a renal biopsy.