title: Epidemiology of Histologically Proven Glomerulonephritis in Africa: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  Glomerulonephritis (GN) is a leading cause of end-stage renal disease (ESRD) in Africa. Data on epidemiology and outcomes of glomerular diseases from Africa is still limited. We conducted a systematic review on the epidemiology of histologically proven glomerular diseases in Africa between 1980 and 2014.
  
  
  METHODS
  We searched literature using PubMed, AfricaWide, the Cumulative Index to Nursing and Allied Health Literature on EBSCO Host, Scopus, African Journals online databases, and the African Index Medicus, for relevant studies. The review was conducted using standard methods and frameworks using only biopsy-confirmed data.
  
  
  RESULTS
  Twenty four (24) studies comprising 12,093 reported biopsies from 13 countries were included in this analysis. The median number of biopsies per study was 127.0 (50-4436), most of the studies (70.0%) originated from North Africa and the number of performed kidney biopsies varied from 5.2 to 617 biopsies/year. Nephrotic syndrome was the commonest indication of renal biopsy. The frequency of reported primary pathologic patterns included, minimal change disease (MCD); 16.5% (95%CI: 11.2-22.6), focal segmental glomerulosclerosis (FSGS); 15.9% (11.3-21.1), mesangiocapillary GN (MCGN); 11.8% (9.2-14.6), crescentic GN; 2.0% (0.9-3.5) and IgA nephropathy 2.8% (1.3-4.9). Glomerular diseases related to hepatitis B and systemic lupus erythematosus had the highest prevalence among assessed secondary diseases: 8.4% (2.0-18.4) and 7.7% (4.5-11.7) respectively. There was no evidence of publication bias and regional differences were seen mostly for secondary GNs.
  
  
  CONCLUSIONS
  Glomerular diseases remain poorly characterized in sub-Saharan Africa due to declining renal biopsy rates and consequent paucity of data on pathologic patterns of key renal diseases. Development of renal biopsy registries in Africa is likely to enable adequate characterization of the prevalence and patterns of glomerular diseases; this could have a positive impact on chronic kidney disease evaluation and treatment in the African continent since most glomerulopathies are amenable to treatment.
authors.affiliation: E13 Renal Unit, Groote Schuur Hospital and Division of Nephrology and Hypertension, University of Cape, Observatory, Cape Town, South Africa.
authors.forename: Ikechi G
authors.initials: IG
authors.lastname: Okpechi
authors.affiliation: E13 Renal Unit, Groote Schuur Hospital and Division of Nephrology and Hypertension, University of Cape, Observatory, Cape Town, South Africa.
authors.forename: Oluwatoyin I
authors.initials: OI
authors.lastname: Ameh
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Canada.
authors.forename: Aminu K
authors.initials: AK
authors.lastname: Bello
authors.affiliation: Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche Paris, France; Sorbonne Universités, Université Pierre and Marie Curie, Paris, France; and Assistance Publique-Hôpitaux de Paris, Department of Nephrology and Dialysis, Tenon Hospital, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Ronco
authors.affiliation: E13 Renal Unit, Groote Schuur Hospital and Division of Nephrology and Hypertension, University of Cape, Observatory, Cape Town, South Africa.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Swanepoel
authors.affiliation: Non-Communicable Diseases Research Unit, South African Medical Research Council & University of Cape Town, Cape Town, South Africa.
authors.forename: Andre P
authors.initials: AP
authors.lastname: Kengne
mesh_terms: D000349:Africa / Q000453:epidemiology; D001706:Biopsy; D005260:Female; D005921:Glomerulonephritis / Q000453:epidemiology* / Q000473:pathology; D005923:Glomerulosclerosis, Focal Segmental / Q000453:epidemiology* / Q000473:pathology; D006509:Hepatitis B / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D007668:Kidney / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000473:pathology; D008297:Male; D009404:Nephrotic Syndrome / Q000453:epidemiology* / Q000473:pathology