Distribution of Biopsy-Proven Presumed Primary Glomerulonephropathies in 2000-2011 Among a Racially and Ethnically Diverse US Population

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• 作者：John J. Sim ; MD¹ ; ^{john.j.sim@kp.org" class="auth_mail" title="E-mail the corresponding author} ; Michael Batech ; DrPH² ; Aviv Hever ; MD³ ; Teresa N. Harrison ; SM² ; Taurino Avelar ; MD¹ ; Michael H. Kanter ; MD⁴ ; Steven J. Jacobsen ; MD ; PhD²
• 关键词：Primary glomerulonephropathy ; glomerulonephritis ; nephrotic syndrome ; focal segmental glomerulosclerosis (FSGS) ; membranous glomerulonephritis (MGN) ; minimal change disease (MCD) ; IgA nephropathy (IgAN) ; epidemiology ; race/ethnic predilection ; kidney biopsy ; case series
• 刊名：American Journal of Kidney Diseases
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：68
• 期：4
• 页码：533-544
• 全文大小：368 K

文摘

The incidence and distribution of primary glomerulonephropathies vary throughout the world and by race and ethnicity. We sought to evaluate the distribution of primary glomerulonephropathies among a large racially and ethnically diverse population of the United States.

Study Design

Case series from January 1, 2000, through December 31, 2011.

Setting & Participants

Adults (aged ≥ 18 years) of an integrated health system who underwent native kidney biopsy and had kidney biopsy findings demonstrating focal segmental glomerulosclerosis (FSGS), membranous glomerulonephritis (MGN), minimal change disease (MCD), immunoglobulin A nephropathy (IgAN), and other.

Outcomes

Rates and characteristics of the most common primary glomerulonephropathies overall and by race and ethnicity.

Results

2,501 patients with primary glomerulonephropathy were identified, with a mean age 50.6 years, 45.7% women, 36.1% Hispanics, 31.2% non-Hispanic whites, 17.4% blacks, and 12.4% Asians. FSGS was the most common glomerulonephropathy (38.9%) across all race and ethnic groups, followed by MGN (12.7%), MCD (11.0%), IgAN (10.2%), and other (27.3%). The FSGS category had the greatest proportion of blacks, and patients with FSGS had the highest rate of poverty. IgAN was the second most common glomerulonephropathy among Asians (28.6%), whereas it was 1.2% among blacks. Patients with MGN presented with the highest proteinuria (protein excretion, 8.3 g) whereas patients with FSGS had the highest creatinine levels (2.6 mg/dL). Overall glomerulonephropathy rates increased annually in our 12-year observation period, driven by FSGS (2.7 cases/100,000) and IgAN (0.7 cases/100,000). MGN and MCD rates remained flat.

Limitations

Missing data for urine albumin and sediment, indication bias in performing kidney biopsies, and inexact classification of primary versus secondary disease.

Conclusions

Among a racially and ethnically diverse cohort from a single geographical area and similar environment, FSGS was the most common glomerulonephropathy, but there was variability of other glomerulonephropathies based on race and ethnicity.