Patterns of renal disease in Cape Town South Africa: a 10-year review of a single-centre renal biopsy database

Abstract

Background: The patterns of glomerular diseases have been widely reported from different regional and national biopsy registries worldwide. However, there are scant studies on the epidemiology of biopsy-proven renal disease, particularly glomerular diseases in sub-Saharan Africa.

Methods: We retrospectively analysed the reports of 1284 native renal biopsies, reviewed by the same pathologist and performed at the Groote Schuur Hospital in Cape Town from 1 January 2000 to 31 December 2009.

Results: The mean age of all the patients biopsied was 36.8 ± 14.0 years with 61.8% of the patients being under 40 years of age. There was a preponderance of females (54.8%). There were more coloured patients (53.7%) than blacks (42.2%) or whites (3.9%). The frequencies of clinical indications for a renal biopsy were nephrotic range proteinuria (52.5%), acute renal failure (21.3%), asymptomatic urinary abnormalities (13.6%), chronic renal failure (6.4%), acute nephritic syndrome (5.8%) and haematuria (0.3%). The frequencies of the primary glomerulonephritis (GN) include mesangiocapillary GN (20.4%), mesangial proliferative GN (19.2%), membranous GN (18.5%), crescentic and necrotizing GN (11.4%), focal and segmental glomerulosclerosis (10.5%), post-infectious GN (8.2%), minimal change disease (6.0%) and IgA nephropathy (5.8%). Lupus nephritis was the most frequent secondary glomerular disease (39.0%) and was also the most frequent cause of the nephrotic range proteinuria (17.2%). HIV-associated nephropathy increased from 6.6% in 2000 to 25.7% in 2009 (P < 0.0001).

Conclusion: Our data are an important contribution to the epidemiology of renal disease in Africa. We hope that this will form the basis for developing a renal biopsy registry in South Africa and across the continent.