Distribution of glomerular diseases in Taiwan: preliminary report of National Renal Biopsy Registry-publication on behalf of Taiwan Society of Nephrology

Abstract

Background: Despite the development of biomarkers and noninvasive imaging tools, biopsy remains the only method for correctly diagnosing patients with unexplained hematuria, proteinuria and renal failure. Renal biopsy has been performed for several decades in Taiwan; however, a national data registry is still lacking until 2013.

Methods: The Renal Biopsy Registry Committee was established within the Taiwan Society of Nephrology in January 2013. A biopsy registry format, including basic demographic data, baseline clinical features, laboratory data, and clinical and pathological diagnosis was developed. Approval from the local institutional review board was obtained in each participating medical center.

Results: From January 2014 to September 2016, 1445 renal biopsies were identified from 17 medical centers. 53.8% cases were reported in men. After excluding renal transplantation, renal biopsies were commonly performed in patients with primary glomerulonephritis (48.1%), secondary glomerulonephritis (36.2%), followed by tubulointerstitial diseases (12.3%) and vascular nephropathy (3.4%). Among primary glomerulonephritis, IgA nephropathy (26.0%), focal segmental glomerulosclerosis (21.6%), and membranous nephropathy (20.6%) were most frequently diagnosed. Diabetic nephropathy (22.4%) and lupus nephritis (21.8%) were the most common among secondary glomerulonephritis. Patients with minimal change disease and membranous nephropathy had heavier proteinuria than those with focal segmental glomerulosclerosis and IgA nephropathy (P < 0.001). Patients with minimal change disease had higher serum IgM and IgE levels. The most common cause of nephrotic syndrome in primary glomerular disease was membranous nephropathy (28.8%), followed by minimal change disease (28.2%). IgA nephropathy was the leading cause of chronic nephritic syndrome, acute nephritic syndrome, and persistent hematuria. The incidence of primary glomerulonephritis was approximately 2.19 in 100,000/year.

Conclusions: This is the first report of the National Renal Biopsy Registry in Taiwan. IgA nephropathy is the most common primary glomerulonephritis, while membranous nephropathy is the most common cause of nephrotic syndrome. Primary glomerulonephritis distribution in Taiwan is slightly different from that in other Asian countries.

Keywords: Glomerulonephritis; IgA nephropathy; Renal biopsy.

Fig. 1

The frequency of classification of clinical diagnosis (n = 1467). Nephrotic syndrome, acute kidney injury, and chronic nephritic syndrome were the most common reasons for renal biopsy. RPGN, rapidly progressive glomerulonephritis syndrome

Fig. 2

The frequency of different forms of biopsy-proven pathological diagnoses excluding renal transplantation (n = 1281). Primary glomerulonephritides accounted for 48.1%, secondary glomerulonephritides accounted for 36.2%, whereas tubulointerstitial diseases accounted for 12.3%. IgA nephropathy was the most frequent diagnoses among primary glomerulonephritides. On the other hand, diabetic nephropathy and lupus nephritis were the most common among secondary glomerulonephritides

Fig. 3

The frequency of biopsy proven primary glomerulonephritides (n = 616). IgA nephropathy, FSGS, MGN and MCD were the most common diagnoses

Fig. 4

Comparison of frequency of IgA nephropathy in primary glomerular diseases in different countries. Adapted from Zhou et al. [7] with modification