Palma Raphael Hemann, Soares Rafaela Gageiro Luchesi, Meinerz Gisele, Keitel Elizete
Graduate Program in Pathology Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil.
Nephrology Department, Santa Casa de Porto Alegre Hospital, Porto Alegre, Brazil.
J Nephrol. 2025 Sep 16. doi: 10.1007/s40620-025-02418-y.
Glomerulonephritis (GN) is a group of kidney disorders marked by glomerular damage, leading to proteinuria, hematuria, hypertension, and impaired kidney function. Despite advancements in diagnostics, kidney biopsy remains the gold standard for diagnosis. The prevalence of GN varies globally, with Latin America showing a significant increase in incidence rates.
This systematic review adhered to PRISMA guidelines and included observational studies from PubMed, Embase, Cochrane, and SciELO databases. Studies were selected based on their focus on the prevalence of GN and its subtypes in Latin America from 2000 onward. The quality of the studies was assessed using the Newcastle-Ottawa Scale adapted for cross-sectional studies.
Following the search, a total of 4336 articles were screened. Of these, 49 underwent full-text review, and 35 met the inclusion criteria, encompassing 61,979 kidney biopsies analyzed across studies conducted in Latin America. The studies spanned a time frame of 1-35 years, with a mean age at biopsy ranging from 28 to 57 years. Focal Segmental Glomerulosclerosis (FSGS) and Lupus Nephrtis were the most frequent primary and secondary glomerulopathies. Nephrotic syndrome was the leading indication for biopsy, and electron microscopy was only reported in 17 studies. Few studies reported data on estimated glomerular filtration rate (eGFR), interstitial fibrosis, and tubular atrophy. Furthermore, subclassification of FSGS into primary and secondary forms was performed in only four studies. Most countries in Latin America reported kidney biopsy rates below 50 per million population per year (pmp/yr), substantially lower than those observed in high-income countries, where rates commonly exceed 100-200 pmp/yr.
The epidemiology of glomerulonephritis in Latin America is heterogeneous, with marked regional differences and predominance of FSGS as the leading primary GN; however, data on primary FSGS (pFSGS) are lacking. Compared to high-income countries, most Latin American countries report significantly lower rates of kidney biopsies per million population, which, combined with limited diagnostic resources, may contribute to the underdiagnosis and potential misclassification of glomerular diseases.
肾小球肾炎（GN）是一组以肾小球损伤为特征的肾脏疾病，可导致蛋白尿、血尿、高血压和肾功能损害。尽管诊断技术有所进步，但肾活检仍是诊断的金标准。GN的患病率在全球范围内各不相同，拉丁美洲的发病率显著上升。
本系统评价遵循PRISMA指南，纳入了来自PubMed、Embase、Cochrane和SciELO数据库的观察性研究。研究的选择基于其对2000年以来拉丁美洲GN及其亚型患病率的关注。使用适用于横断面研究的纽卡斯尔-渥太华量表评估研究质量。
检索后，共筛选了4336篇文章。其中，49篇进行了全文审查，35篇符合纳入标准，涵盖了拉丁美洲开展的各项研究中分析的61979例肾活检。这些研究的时间跨度为1至35年，活检时的平均年龄在28至57岁之间。局灶节段性肾小球硬化（FSGS）和狼疮性肾炎是最常见的原发性和继发性肾小球疾病。肾病综合征是活检的主要指征，仅17项研究报告了电子显微镜检查结果。很少有研究报告估计肾小球滤过率（eGFR）、间质纤维化和肾小管萎缩的数据。此外，仅在四项研究中对FSGS进行了原发性和继发性形式的亚分类。拉丁美洲的大多数国家报告每年每百万人口的肾活检率低于50例（pmp/yr），远低于高收入国家，高收入国家的肾活检率通常超过100 - 200 pmp/yr。
拉丁美洲肾小球肾炎的流行病学情况各异，存在明显的地区差异，且FSGS作为主要的原发性GN占主导地位；然而，缺乏原发性FSGS（pFSGS）的数据。与高收入国家相比，大多数拉丁美洲国家报告的每百万人口肾活检率显著较低，这与有限的诊断资源相结合，可能导致肾小球疾病的诊断不足和潜在的错误分类。
