Clinical and histopathological patterns of glomerulonephritides among patients at moi teaching and referral hospital in Eldoret, Kenya

Abstract

Background: End stage renal disease (ESRD) affects 3.2 million people globally. The prevalence of ESRD in Kenya is 16 per 1 million populations. Glomerulonephritides (GN) are the leading causes of ESRD globally. In resource limited settings (RLS) histological diagnoses are rare, and treatment is often empiric. As such, limited data exist on types of GN in RSL. Objective: To describe the clinical and histopathological patterns of GN at Moi Teaching and Referral Hospital (MTRH). Methods: This cross sectional study conducted at the MTRH renal and adult medical wards enrolled consecutive participants ≥15 years with nephritis or nephrosis (symptoms and signs of GN including hematuria, body swelling, reduced urine output and hypertension). Demography (age, gender, body mass index) clinical (history& physical examination) and laboratory (cholesterol, albumin, creatinine, complementC3, antinuclear antibody, anti-streptolysin-O titers, complete blood count and urinalysis) data were collected. Renal biopsies were conducted and tissues subjected to histopathological diagnosis by light microscopy. All data were collected using a structured questionnaire, keyed into Microsoft Excel® database and analysed using STATA version 13®. Descriptive statistics were summarized in tables and graphs and correlations were done using Pearson’s Chi Square test. Results: Of the 42 participants who had a renal biopsy conducted 24(57.8%) were female, median age was 35 years (IQR: 24, 45) and majority (86.3%) had hematuria. Nephrosis and nephritis accounted for 46.7% of the clinical presentations each. Three (6.7%) of the cases were indeterminate. Based on renal histopathology results the most common patterns were: Focal Segmental Glomerulosclerosis (FSGS – 23.8%); Lupus Nephritis (LN – 19.0%); Minimal Change Disease (MCD – 11.9%); and Membrano-proliferative glomerulonephritis (MPGN – 9.5%). There was no relationship between the type of clinical syndrome and the histological pattern (p = 0.129). Conclusion: The most common GN at MTRH on histological diagnosis is FSGS. Recommendation: Empiric treatment of patients with GN based on clinical presentation should be discouraged since no significant association was established between clinical and histological findings