Summary
Glomerular diseases account for a significant proportion of chronic kidney disease
in low-income and middle-income countries (LMICs). The epidemiology of glomerulonephritis
is characterized inadequately in LMICs, largely owing to unavailable nephropathology
services or uncertainty of the safety of the kidney biopsy procedure. In contrast
to high-income countries where IgA nephropathy is the dominant primary glomerular
disease, focal segmental glomerulosclerosis is common in large populations across
Latin America, Africa, Middle East, and South East Asia, while IgA nephropathy is
common in Chinese populations. Despite having a high prevalence of known genetic and
viral risk factors that trigger focal segmental glomerulosclerosis, membranoproliferative
glomerulonephritis also is common in adults and children in some African countries.
Treatment of glomerular diseases in adults and children in LMICs largely is dependent
on corticosteroids in combination with other immunosuppressive therapy, which often
is cyclophosphamide because of its ready availability and low cost of treatment, despite
significant adverse effects. Partial and/or complete remission status reported from
studies of glomerular disease subtypes vary across LMIC regions, with high rates of
kidney failure, mortality, and disease, and treatment complications often reported.
Improving the availability of nephropathology services and ensuring availability of
specific therapies are key measures to improving glomerular disease outcomes in LMICs.
Keywords
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Published online: February 10, 2023
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