Temporal and Demographic Trends in Glomerular Disease Epidemiology in the Southeastern United States, 1986-2015

Abstract

Background and objectives: Large-scale, contemporary studies exploring glomerular disease epidemiology in the United States are lacking. We aimed to determine 30-year temporal and demographic trends in renal biopsy glomerular disease diagnosis frequencies in the southeastern United States.

Design, setting, participants, & measurements: In this cross-sectional, observational study, we identified all patients with a native kidney biopsy specimen showing one of 18 widely recognized glomerular disease diagnoses referred to the University of North Carolina Chapel Hill Division of Nephropathology between 1986 and 2015. Biopsy era (1986-1995, 1996-2005, and 2006-2015) and demographics (age, sex, and race) were our primary and secondary predictors, respectively, and the relative frequency of each glomerular disease diagnosis was our primary outcome.

Results: Among 21,374 patients (mean age =48.3±18.3 years old; 50.8% men; 56.8% white; 38.3% black; 2.8% Latino; 1.4% Asian; 0.8% other), the frequency of diabetic glomerulosclerosis in renal biopsy specimens increased dramatically over the three decades (5.5%, 11.4%, and 19.1% of diagnoses, respectively; P for trend <0.001). The frequency of FSGS initially increased but then declined (22.6%, 27.2%, and 24.7%, respectively; P for trend =0.64). The frequencies of other common glomerular disease subtypes remained stable (IgA nephropathy and ANCA/pauci-immune GN) or declined (minimal change disease, membranous nephropathy, membranoproliferative GN, and lupus nephritis). These temporal trends were largely preserved within all demographic subgroups, although cross-sectional frequency distributions differed according to age, sex, and race.

Conclusions: We identified significant changes in relative renal biopsy frequencies of many glomerular disease subtypes over three decades. Temporal trends were consistently observed within all major demographic groups, although relative predominance of individual glomerular disease subtypes differed according to patient age, sex, and race. We propose that exploration of behavioral and environmental exposures that likely underlie these findings should be the focus of future hypothesis-driven research.

Keywords: Adult; African Americans; Aged; Antibodies, Antineutrophil Cytoplasmic; Biopsy; Cross-Sectional Studies; Demography; Diabetic Nephropathies; Environmental Exposure; European Continental Ancestry Group; Hispanic Americans; Humans; Kidney Glomerulus; Male; MeSH Browser: Southeastern United States Southeastern United States; Middle Aged; Nephrosis, Lipoid; clinical epidemiology; glomerular disease; glomerulonephritis; histopathology; lupus nephritis; renal biopsy.

Figure 1.

Temporal trends in the relative renal biopsy frequencies of the most common glomerular disease subtypes, 1986–2015. (A) Frequencies of the eight most common glomerular disease subtypes shown as a proportion of the entire cohort. (B) Frequencies of the seven most common glomerular disease subtypes shown as a proportion of remaining subtypes after excluding diabetic glomerulosclerosis (GS). IgAN, IgA nephropathy; MPGN, membranoproliferative GN excluding dense deposit disease.

Figure 2.

Absolute renal biopsy diagnosis frequencies of the most common glomerular disease subtypes according to patient age category. (A) All subtypes: number of patients with each of the eight most common glomerular disease subtypes shown. (B) Nephrotic subtypes: number of patients with each of the eight most common glomerular disease subtypes that often present with nephrotic syndrome shown (Fabry disease and collagenofibrotic glomerulopathy not shown). (C) Nephritic subtypes: number of patients with each of the eight glomerular disease subtypes that often present clinically with nephritic features shown. DDD, dense deposit disease; GBM, glomerular basement membrane; GS, glomerulosclerosis; IgAN, IgA nephropathy; MIDD, monoclonal immune deposition disease; MPGN, membranoproliferative GN; TBM, thin basement membrane.

Figure 3.

Absolute renal biopsy diagnosis frequencies of the most common glomerular disease subtypes according to patient age category stratified by sex and race. GS, glomerulosclerosis; IgAN, IgA nephropathy; MPGN, membranoproliferative GN.

Figure 4.

Relative renal biopsy diagnosis frequencies of the most common glomerular disease subtypes according to patient age category and typical mode of clinical presentation. (A) nephrotic syndrome; (B) nephritic features. DDD, dense deposit disease; GBM, glomerular basement membrane; GS, glomerulosclerosis; IgAN, IgA nephropathy; MIDD, monoclonal immune deposition disease; MPGN, membranoproliferative GN; TBM, thin basement membrane.