The Spectrum of Biopsy-Proven Glomerular Disease in China: A Systematic Review Translated title: 中国患者肾穿刺肾小球疾病谱的系统评价

Abstract

Background:

Chronic kidney disease has become a leading public health concern in China, as it is associated with increased morbidity, mortality, and costs. However, the overall situation regarding common glomerular diseases in China remains unclear. Hence, the aim of this study was to assess the national profile of the common types of glomerulonephritis in China.

Methods:

We searched Medline, Embase, Cochrane Library, CNKI, SinoMed, VIP, and Wanfang databases for English and Chinese language articles from inception to September 2017. We also collected potentially relevant studies and reviews using a manual search. The following words in combinations are as keywords: “renal biopsy”, “kidney pathological diagnosis”, and “spectrum of pathological types”.

Results:

We identified 23 studies involving 176,355 patients from 15 provinces/cities in China. The detection rates of primary glomerulonephritis (PGN) and secondary glomerulonephritis (SGN) were 0.740 and 0.221, respectively. Over the past 30 years, the top five types of PGN were immunoglobulin A nephropathy (IgAN; 24.3%), mesangial proliferative glomerulonephritis (MsPGN; 10.5%), membranous nephropathy (MN; 12.6%), minimal change disease (MCD; 9.8%), and focal segmental glomerulosclerosis (FSGS; 4.6%), and the top four types of SGN were lupus nephritis (LN; 8.6%), Henoch-Schönlein purpura glomerulonephritis (4.1%), hepatitis B virus-associated glomerulonephritis (HBV-GN; 2.6%), and diabetic nephropathy (DN; 1.6%). The proportion of MN, MCD, HBV-GN, and DN tended to increase, while those of IgAN, MsPGN, FSGS, and LN tended to drop.

Conclusions:

Although the incidence of SGN is increasing gradually, PGN is still the leading form of kidney disease in patients undergoing renal biopsies in China. IgAN and LN are the most common types of PGN and SGN, respectively. Differences between regions are related to various factors such as nationality, environment, and diet. Furthermore, unified standards and norms for evaluating renal biopsies are urgently needed.

摘要

背景：

慢性肾脏病发病率高，导致死亡风险高，医疗花费巨大，已成为中国一个令人瞩目的公共卫生问题。然而，中国各地各种不同病理类型肾小球疾病的分布情况目前仍不清楚。

方法：

我们检索了MEDLINE，EMBASE，Cochrane图书馆，CNKI，SinoMed，VIP和万方数据库，语言限定为英文或中文，时间截止2017年9月。此外，我们也对会议论文，学位论文等灰色文献相关进行了人工搜索。检索词为下列组合：“肾活检”，“肾脏病理诊断”和“病理类型谱”。

结果：

我们最终纳入了23项研究，涉及中国15个省市的176,355名患者。原发性和继发性肾小球肾炎的检出率分别为0.740和 0.221。在过去30年中，肾穿刺最常见的5种原发性肾小球疾病分别是：IgA肾病（IgAN; 24.3％），系膜增生性肾小球肾炎 （MsPGN; 10.5％），膜性肾病（MN; 12.6％），微小病变（MCD; 9.8％ ）和局灶节段性肾小球硬化（FSGS; 4.6％）。最常 见的继发性肾小球疾病依次为：狼疮性肾炎（LN; 8.6％），过敏性紫癜性肾炎（HSP-GN; 4.1％），乙型肝炎病毒相关性肾小球肾炎（HBV-GN; 2.6％）和糖尿病肾病（DN; 1.6％）。 其中MN，MCD，HBV-GN和DN呈增加趋势，IgAN，MsPGN，FSGS和LN呈下降趋势。

结论：

尽管继发性肾小球疾病检出率逐渐增高，临床最常见的仍是原发性肾小球疾病。IgAN和LN分别是最常见的原发和继发肾脏病理类型。不同地区之间疾病检出率存在明显差异，可能与基因、环境、饮食等多种因素有关。另外，肾活检病理诊断的规范化也是一个亟待解决的问题。