Department of Medicine, University of Uyo, Uyo, Nigeria.
Department of Paediatrics, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria.
Semin Nephrol. 2022 Sep;42(5):151316. doi: 10.1016/j.semnephrol.2023.151316. Epub 2023 Feb 9.
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.
肾小球疾病在低收入和中等收入国家（LMICs）占慢性肾脏病的很大比例。肾小球肾炎的流行病学在 LMICs 中描述不足，主要是由于缺乏肾脏病病理学服务或对肾活检程序的安全性存在不确定性。与高收入国家中 IgA 肾病是主要的原发性肾小球疾病不同，局灶节段性肾小球硬化症在拉丁美洲、非洲、中东和东南亚的大部分人群中很常见，而 IgA 肾病在中国人群中很常见。尽管存在已知的遗传和病毒危险因素，这些危险因素会引发局灶节段性肾小球硬化症，但在一些非洲国家，膜增殖性肾小球肾炎在成人和儿童中也很常见。在 LMICs 中，成人和儿童肾小球疾病的治疗主要依赖于皮质类固醇联合其他免疫抑制疗法，由于环磷酰胺易于获得且治疗成本低，因此经常使用环磷酰胺，尽管其存在严重的不良反应。在不同的 LMIC 地区，肾小球疾病亚型研究报告的部分和/或完全缓解状态有所不同，常伴有高比例的肾衰竭、死亡率和疾病以及治疗并发症。提高肾脏病病理学服务的可及性并确保特定疗法的可及性是改善 LMICs 肾小球疾病结局的关键措施。
