Prevalence of Glomerular Diseases in Saudi Arabia

Prevalence of Glomerular Diseases in Saudi Arabia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence of Glomerular Diseases in Saudi Arabia Manal E. Alotaibi, Laila A. Alharbi, Fahd Almalki, Ibrahim Tawhari, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6115444/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Glomerular diseases are marked as a significant public health concern across Saudi Arabia. The prevalence of these diseases keeps on evolving with increased patterns which is influenced by demographic shifts, comorbid conditions, and advancements in diagnostic methods. This study examines the prevalence and distribution of glomerular diseases in Saudi Arabia. Methods: A systematic review of was conducted using PRISMA methodology and research articles were analyzed and assessed on a preestablished screening criteria. Results: The prevalence of CKD in Saudi Arabia ranges from 4.76% to 5.7%, with focal segmental glomerulosclerosis (FSGS) being the most commonly diagnosed primary glomerular disease. The diabetic nephropathy is a leading cause of CKD and end-stage renal disease (ESRD) which indicated increased incidence among type 2 diabetes patients. The gender differences were also observed with males showing elevated CKD prevalence. It was also found that lupus nephritis was more prevalent in females. Conclusion: Glomerular diseases in Saudi Arabia are surging necessitating early screening and improved diagnostic strategies. The targeted interventions to mitigate disease progression are also recommended for future researches and medical interventions. Glomerular disease chronic kidney disease Saudi Arabia renal biopsy nephropathy epidemiology Figures Figure 1 Introduction Glomerular diseases are a heterogeneous disorder of the glomeruli, the microscopic filtration units of the kidney. Disruption in the normal filtration process during these conditions result in proteinuria, hematuria, and finally progressive kidney dysfunction due to impaired renal function (Aslam et al., 2013 ). Primary and secondary glomerular diseases are then differentiated by whether the disease relates to the kidney (primary) or results from some other systemic condition such as diabetes mellitus, autoimmune diseases, or chronic infections (secondary). The increasing prevalence of glomerular diseases all over the globe is attributed to the increased incidences of metabolic disorders, the change in lifestyle, and exposure to environmental factors (Mousa et al., 2021 ). This is also a concern in Saudi Arabia with high prevalence of diabetes, obesity and hypertension leading to increase in the chronic kidney disease (CKD) (Almalki et al., 2021 ) The form of the epidemiology of glomerular diseases in Saudi Arabia has been influenced by genetic, environmental, and demographic factors. FSGS prevalence is said to be on the rise in the region, and has been linked to high rates of metabolic syndrome and obesity, both items of risk for glomerular (Assiry et al., 2022 ). IgA nephropathy (IgAN), the commonest cause of glomerulonephritis worldwide has been reported at a high rate in Saudi Arabia; but its exact prevalence is poorly documented because of the lack of renal biopsy data (Al-Shammari et al., 2020 ). In addition, genetic predisposition also plays a role as the Saudi population has high rates of consanguinity. Populations with frequent inter-family marriages, due to hereditary causes have heavier burden of glomerular diseases like inherited glomerular diseases Alport syndrome and familial FSGS (Al-Hamed et al., 2022 ). Diabetic nephropathy is still the most common secondary glomerular disease in Saudi Arabia because of the prevalence of diabetes mellitus. It is reported by the World Health Organization (WHO) that Saudi Arabia has the world highest level of diabetes which exceeds 30 percent of adults (Alzahrani et al., 2022 ). Diabetic nephropathy is responsible for more than 60% of end stage renal disease and dialysis dependency in Saudi Arabia accounting for nearly 40% of the diabetic patients (Safdar et al., 2021 ). As the disease impaires kidney function and increases the risk of cardiovascular morbidity and mortality to a significant extent (Almalki et al., 2018). Other common glomerular diseases, such as lupus nephritis, are frequently encountered in Saudi clinical settings where studies have reported a relatively high prevalence in the Saudi Arabian compared to the Western population (Naser et al., 2021 ). The patients with systemic lupus erythematosus (SLE) in Saudi Arabia exact the renal involvement most commonly worst requiring aggressive immunosuppressive therapy and long term management to prevent progression of CKD. In the kingdom of Saudi Arabia, glomerular disease burden is largely attributable to the infectious agent. The region is experienced by many patients with hepatitis B and C infections (both known to cause immune mediated glomerular injury), particularly those of the high risk groups. Chronic viral infections including hepatitides B and C can lead to membranous nephropathy and membranoproliferative glomerulonephritis and both of which are associated with persistent kidney damage and increased risk of ESRD (Alkhalifah et al., 2023 ). Furthermore, some studies emerging evidence suggests that environmental toxins, prolonged use of nephrotoxic drugs (such as NSAIDs) and industrial pollutants have additive or predisposing role in the progression of glomerular disease, but further works in Saudi Arabia are still limited (AlMaawali et al., 2022 ). Glomerular diseases represent a big clinical and public health burden in Saudi Arabia. Renal replacement therapies, including dialysis and kidney transplantation, are required and require costly therapy for patients with progress to CKD and ESRD as a result of glomerular disease. Glomerular diseases are a major underlying cause for renal failure in patients receiving dialysis depending on their renal function, so the demand for dialysis has risen steadily (Alshahrani et al., 2022 ). In addition CKD patients frequently suffer from reduced quality of life as a result of anemia, mineral bone disorders and cardiovascular disease, adding to the rates of hospitalization and healthcare expenditures (AlMaawali et al., 2022 ). In spite of the high degree of glomerular disease burden, several challenges in diagnosis and treatment of glomerular diseases exist in Saudi Arabia. Not all healthcare facilities have either UNO renal biopsy available uniformly or have the capability of processing a renal biopsy specimen sufficiently to render a positive diagnosis in the majority of cases of glomerular disease (Al-Hamed et al., 2022 ). In many patients with early stage kidney disease, no symptoms arise and plenty has not been done with routine screening programs such as urine protein analysis and eGFR assessments in primary care settings. Moreover, patients are unaware of kidney disease even more so, which delayed medical attention and CKD progression into advanced stages (AlMaawali et al., 2022 ).. Although these diseases are increasing in prevalence in Saudi Arabia, there is a need for enhanced epidemiological studies, national renal registries, as well as development of improved diagnostic tools. This will aid in the diagnosis, treatment and prevention of glomerular diseases in different demographic groups. In Saudi Arabia, diabetes, hypertension, and obesity are all increasing in weight and the incidence of glomerular diseases is expected to accumulate, which makes it necessary to take into account a comprehensive approach to public health to address this issue. The strengthening of nephrology services and increasing awareness among healthcare providers is a vital step for improvement. The implementation of early screening initiatives are also crucial in mitigating the impact of glomerular diseases and reducing their progression to ESRD. Methods This study employs a systematic review research design to assess the prevalence of glomerular diseases in Saudi Arabia. The methodology follows rigorous epidemiological principles to ensure accurate data collection, analysis, and interpretation. Literature Search Strategy A comprehensive literature search was conducted to evaluate the prevalence of glomerular diseases in Saudi Arabia. Major electronic databases, including PubMed, MEDLINE, Cochrane Library, and Google Scholar, were systematically searched to identify relevant studies. The search strategy was designed using a combination of Medical Subject Headings (MeSH) terms and Boolean operators (AND, OR) to ensure an extensive retrieval of studies. Keywords were selected based on their relevance to glomerular diseases and were categorized systematically, as presented in Table 1 . Table 1 Keywords Used for Search Strategy Category Keywords and MeSH Terms Glomerular Diseases "glomerulonephritis", "glomerular disease", "chronic kidney disease", "IgA nephropathy", "nephrotic syndrome", "focal segmental glomerulosclerosis" Prevalence "epidemiology", "prevalence", "incidence", "population-based study" Saudi Arabia "Saudi Arabia", "Middle East", "Arab population" Diagnostic Approaches "renal biopsy", "immunofluorescence", "light microscopy", "electron microscopy" Risk Factors "diabetes mellitus", "hypertension", "autoimmune diseases", "genetic predisposition" Study Selection Process The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for study selection to ensure transparency and reproducibility. The initial search yielded a broad range of articles, which were subsequently screened for eligibility based on predefined inclusion and exclusion criteria. Inclusion Criteria: Studies reporting prevalence data of glomerular diseases in Saudi Arabia. Cross-sectional, cohort, and retrospective studies published in peer-reviewed journals. Studies conducted on human subjects with histopathological confirmation of glomerular disease. Articles published in English or with an available English translation. Exclusion Criteria: Case reports, review articles, and editorials. Studies focusing on non-Saudi populations or without specific regional data. Articles with insufficient or unclear methodology regarding disease classification. Data Extraction and Management Data from the included studies were extracted independently by two reviewers using a standardized data extraction form. Key variables included study design, sample size, patient demographics, diagnostic methods, and prevalence rates of specific glomerular diseases. Extracted data were recorded and managed using Microsoft Excel to ensure accuracy and facilitate the removal of duplicate records. By implementing this comprehensive methodological framework, the study aims to provide an accurate and detailed understanding of the prevalence of glomerular diseases in Saudi Arabia, offering insights for healthcare policy and management strategies. Results And Discussion Included studies demonstrated a significant finding in prevalence of glomerular diseases in Saudia Arabia population. Table 2 presents the characteristics of studies included in this research. Table 2 Characteristics of Studies Included Study Study design Intervention Key findings Al-Wakeel ( 2016 ) Cross-sectional study Comparison of estimated glomerular filtration rate (eGFR) using CKD-EPI and MDRD equations with GFR measured by inulin clearance in adult Saudi patients with CKD Compared to inulin clearance, the CKD-EPI creatinine equation gave the most accurate eGFR with little bias and narrow limits of agreement. Other formulae underestimated GFR, including CKD-EPI cystatin C, creatinine-C, and MDRD. The prevalence of CKD in Saudi Arabia is mentioned as 5.7%. Bahrani et al. ( 2024 ) Cross-sectional study The prevalence of CKD in type-2 diabetics in Al-Ahsa, Saudi Arabia, and associated risk factors CKD was identified in 41.1% of subjects, with 33.2% having mild to substantially reduced GFRs. Male patients had more reduced GFRs than females. Alshehri et al. ( 2025 ) Cross-sectional study Assessment of the prevalence of CKD and associated risk factors across Saudi Arabia The study found that CKD is a prevalent health issue in Saudi Arabia The overall prevalence of CKD was found to be 4.76%, with stage 3 CKD being the most common at 3.5%. The prevalence was higher among males (5.83%) compared to females (3.88%) and increased significantly with age, from 0.45% in individuals aged 18–29 years to 50.94% in those aged 90 years or older. AlFaadhel et al. ( 2019 ) Multicenter retrospective study Analysis of kidney biopsy data from multiple centers across Saudi Arabia over a 20-year period to determine the prevalence and trends of glomerular diseases FSGS diagnoses increased and membranous nephropathy decreased over 20 years. The prevalence of diabetic nephropathy increased from 1.4% in the First era to 10.2% in the last one. AlMatham et al. ( 2017 ) Retrospective study Study of 166 kidney biopsies from 2007 to 2016 at a Saudi tertiary referral center to determine glomerulonephritis prevalence and types. Primary GN was detected in 61.4% of biopsies, with FSGS being the most prevalent subtype. Lupus nephritis, especially class IV, dominated 38.6% of secondary GN cases. Alhasan et al. ( 2020 ) Retrospective study renal histopathology spectrum in children with kidney diseases in Saudi Arabia, 1998–2017 The findings revealed that secondary glomerulonephritis accounted for 42.3% of the cases, with lupus nephritis being the most common cause, noted in 20.7% of the cases. Among primary glomerular diseases, minimal change disease and focal segmental glomerulosclerosis were the most prevalent, together constituting 59% of the cases. Al-Hussain et al. ( 2017 ) Retrospective study Analysis of renal biopsy specimens from crescent-detected glomerulonephritis patients to assess prevalence and kinds. Immune complex-mediated GN was the most common, accounting for 71.8% of cases, followed by pauci-immune GN at 20.5% and anti-glomerular basement membrane (GBM) antibody GN at 7.7%. The percentage of glomeruli with crescents varied among these types, with anti-GBM disease showing the highest mean at 93.3%, pauci-immune GN at 48.2%, and immune complex GN at 30.9%. Jalalah ( 2020 ) Retrospective study Analyzing renal biopsy data from a single Saudi Arabian center over 10 years to determine glomerular disease trends. Minimal change illness and postinfectious GN (PIGN) rose from 0% in period 1 to 6.5% in period 2. MCD fell from 13.5% in period 1 to 5.9% in period 2. For both eras, membrane GN is the most prevalent kind of GN, with comparable percentages (23.8% and 24.2%, respectively). The second condition in period 2 (23%), focal segmental glomerulosclerosis (FSGSC), is immunoglobulin In period 1, MCD is now ranked last rather than fourth, while nephropathy, with 9.6%, moved up to third place. Shawarby et al. ( 2010 ) Retrospective study Analysis of data of patients with nephrotic syndrome Primary glomerulonephritis comprised 80.3% of 233 renal biopsies, with minimal change glomerulopathy being the most frequent at 29.4%. Mesangioproliferative glomerulonephritis followed at 19.8%, and focal/segmental glomerulosclerosis at 15.5%. Lupus nephritis dominated secondary glomerulonephritis, representing 71.7% of that 19.7% subset. This data highlights a regional predominance of minimal change glomerulopathy and lupus nephritis, alongside a lower prevalence of membranoproliferative glomerulonephritis (9.6%). Minshawy et al. ( 2014 ) Retrospective study Analysis of Tabuk ESRD patients' medical records to determine prevalence, causes, and outcomes. Diabetic nephropathy and hypertension nephrosclerosis elevated ESRD in Tabuk. ESRD is rising in the region, hence the authors propose greater prevention and early detection. The outrage of glomerular disease and chronic kidney disease (CKD) in Saudi Arabia has significantly evolved with time, impacted by changing epidemiological trends, technical advancement in diagnostics, and an elevating knowledge of risk factors. Studies in the country collect significant data about patterns of disease, gender prevalence, and effects of co-occurring conditions, all emphasizing the need for intense screening and preventive measures. Among these results, one of the important results is the overall inclined documentation for glomerular disease in Saudi Arabia including focal segmental glomerulosclerosis (FSGS). According to a research by AlFaadhel et al. ( 2019 ) of more than 1,000 biopsy proven, the most common glomerular pathology was FSGS, which is consonant with the explored research by AlMatham et al. ( 2017 )). These outcomes investigated a declining trend in membranoproliferative and mesangioproliferative glomerulonephritis which may be because of the shift of the environmental and genetic factors or significant disease control.However, compared to RPGN, crescentic glomerulonephritis (CGN), a more important type of rapidly progressive glomerulonephritis (RPGN), is of relatively lesser prevalence but not negligible. Unlike Western populations, a prevalence of crescentic GN of 3.2% for renal biopsies (Mosaad et al.,2018). It further indicated the potential genetic and environmental triggers. Gender disparities in glomerular disease have been another region to be discussed. A higher frequency of kidney biopsies in male individuals is documented by most researches. Bakhit et al. ( 2018 ) attribute this to a greater number of comorbidities such as hypertension and diabetes among Saudi men. Some autoimmune-related nephropathies, like lupus nephritis, on the other hand, have a greater predilection among women. Alhasan et al. ( 2020 ) identified that more than 82% of the cases of systemic lupus erythematous (SLE)-associated nephritis were female, further supporting the widely documented link between lupus and female susceptibility. Diabetes continues to be one of the major risk factors for CKD and glomerulopathy in Saudi Arabia. Alwakeel et al. ( 2011 ) indicated that 31.8% of type 2 diabetes patients developed diabetic nephropathy (DN), with significant yearly GFR reduction. Al-Rubeaan et al. ( 2018 ) added more evidence from the SAUDI-DKD study that approximately 37% of cases of diabetic nephropathy progressed to end-stage renal disease (ESRD). Also, Alghaithi (2018) added that diabetes contributed more to CKD and ESRD in Saudi Arabia than it was earlier estimated, and females were more vulnerable. The precision of diagnostic equipment has been a primary area of research, especially for the evaluation of glomerular filtration rates (GFR). Al-Wakeel ( 2016 ) focused on the value of the CKD-EPI creatinine formula in estimating GFR over other prognostic formulas, with special reference to Saudi populations. Bahrani et al. ( 2024 ) also outlined how obesity and hypertension affect decline in GFR, indicating the need for selective screening strategies within certain patient groups. Another critical research by Alshehri et al. ( 2025 ) gathered information from 42 diagnostic labs to emphasize the urge for large-scale screening and preventive measures. This national strategy would go on a higher scale toward early detection and disease control, specifically with the inclining burden of CKD in the origin. The primary rationale for CKD in Saudi Arabia have evolved over the years. Jalalah ( 2020 ) documented an augment in post-infectious glomerulonephritis (PIGN) from 0–6.5% over twenty years, whereas minimal change disease (MCD) rejected from 13.5–5.9%. These changes may exhibit transformation infection trends, better antibiotic use, or genetic factors effecting disease exposure. Likewise, Minshawy et al. ( 2014 ) emphasized that hypertension and diabetes-related complications maintain primacy causes of ESRD, although a significant percentage of cases (33%) had unknown causes, warranting additional inquiry. Implications for Future Research and Clinical Practice Consolidated outcomes from these researches highlight the urgent need for determined changes to decrease the load of glomerular diseases and CKD in Saudi Arabia. Early detection, augmented especially in high-risk classes such as diabetics and hypertensive could have a profound impact on the course of disease. At the same time, the male and female gender stereotypes present us with the opportunity to address particularly personalized treatment of nephrology through the consideration of the specific risks presented in each gender. It is of paramount importance to the formation of more effective prevention and treatment ranges for the fact that current research is focusing on genetic predisposition, environmental factors, and the shifting disease trends. With application of these outcomes into the national health policy, Saudi Arabia will clearly improve renal health results and reduce the rising burden of CKD on the health care system. Conclusion Glomerular diseases constitute a major public health problem in Saudi Arabia as they incipiently raise their incidence due to rise in the prevalence of diabetes, hypertension, obesity and genetic predispositions. The predominant principal of glomerular disease that manifested is focal segmental glomerulosclerosis (FSGS) while diabetic nephropathy and lupus nephritis are the commands diseases. She has also increased rates of kinship participates to hereditary glomerular disorders, such as Alport syndrome. The shifts in the disease trends revealed by epidemiological findings included increases in IgA nephropathy and diabetic nephropathy, and decreases in membranoproliferative glomerulonephritis. For example, diagnostic obstacles are preserved due to limited approach to renal biopsies, incongruous screening, and under diagnosis, particularly in asymptomatic early stages. ESRD is a disease that is becoming more burdensome with higher related healthcare costs pertaining to dialysis and transplantation. This emphasizes the need of additional effort in developing national registries, early detection programs and public guidance initiatives to improve early detection and administration. Integration of the effect of glomerular diseases in Saudi Arabia is reliant upon strengthening of nephrology services and adapting of preventive method aiming to metabolic and infectious risk factors. Declarations Author Contribution MEA: Write the main manuscript, review the manuscript LA: Write the main manuscript and review it FA: make the figures, tables and review the manuscript IT: Analyze and interpret the data, and review the article.MA: Write and review the main manuscript Ethics, Consent to Participate, and Consent to Publish declarations : not applicable. If your study is a clinical trial, then please provide the necessary registration details (registry, trial registration number, and data of registration): The study is not a clinical trial. The manuscript type is a systematic review article. All the data used were referenced accordingly. Data Availability declaration in the manuscript: not applicable. 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Saudi Medical Journal , 39 (4), 354–360. https://doi.org/10.15537/smj.2018.4.21366 Mousa, D., Alharbi, A., Helal, I., Al-Homrany, M., Alhujaili, F., Alhweish, A., Marie, M. A., & Sayyari, A. A. (2021). Prevalence and Associated Factors of Chronic Kidney Disease among Relatives of Hemodialysis Patients in Saudi Arabia. Kidney International Reports , 6 (3), 817–820. https://doi.org/10.1016/j.ekir.2020.12.029 Naser, A. Y., Alwafi, H., Alotaibi, B., Salawati, E., Samannodi, M., Alsairafi, Z., Alanazi, A. F. R., & Dairi, M. S. (2021). Prevalence of Chronic Kidney Diseases in Patients with Diabetes Mellitus in the Middle East: A Systematic Review and Meta-Analysis. International Journal of Endocrinology , 2021 , 1–9. https://doi.org/10.1155/2021/4572743 Safdar, O. Y., Alzahrani, W. A., Kurdi, M. A., Ghanim, A. A., Nagadi, S. A., Alghamdi, S. J., Zaher, Z. F., & Albokhari, S. M. (2021). The prevalence of renal stones among local residents in Saudi Arabia. Journal of Family Medicine and Primary Care , 10 (2), 974–977. https://doi.org/10.4103/jfmpc.jfmpc_262_20 Shawarby, M., Al Tamimi, D., Al Mueilo, S., Saeed, I., Hwiesh, A., Al-Muhanna, F., ... & Khamis, A. H. (2010). A clinicopathologic study of glomerular disease: experience of the King Fahd Hospital of the University, Eastern Province, Saudi Arabia. Hong Kong Journal of Nephrology , 12 (1), 20-30. http://dx.doi.org/10.1016/S1561-5413(10)60005-1 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6115444","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":432757616,"identity":"97d1ed71-76e0-4afe-b6c7-0a981497d0f7","order_by":0,"name":"Manal E. Alotaibi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2ElEQVRIiWNgGAWjYNACgwM8/BAWM1HqGRtAWiQbSNPCcACoi1gtuu3Nxx/8KLgjY3wjeZsEQ4V1YgP/4Qd4tZidOZbY2GPwjMfsRlqZBMOZ9MQGiTQD/Fpu5Bg28BgcBmrJMZNgbDsM1MJAQMv9N4aNf4BajGeAtPwDauE//oGALTyGzSBbDCRAWhqAWhhyCNhyJi1xtgzQLxJnnhVbJBxLN26TyCnAr+X44QMf3/y5Y8/fnrzxxocaa9l+/uMb8GpBBgYMCUCSjWj1YC2jYBSMglEwCrABAIbTSMdtFOSXAAAAAElFTkSuQmCC","orcid":"","institution":"Department of Medicine, Medical College, Umm Al-Qura University (UQU)","correspondingAuthor":true,"prefix":"","firstName":"Manal","middleName":"E.","lastName":"Alotaibi","suffix":""},{"id":432757619,"identity":"1429fa5a-cbb0-4e30-9d9c-69c29fff3fe8","order_by":1,"name":"Laila A. Alharbi","email":"","orcid":"","institution":"Department of Medicine, Medical College, Umm Al-Qura University (UQU)","correspondingAuthor":false,"prefix":"","firstName":"Laila","middleName":"A.","lastName":"Alharbi","suffix":""},{"id":432757620,"identity":"25177713-cecc-49a7-b145-edb30b4dce06","order_by":2,"name":"Fahd Almalki","email":"","orcid":"","institution":"Department of Medicine, Medical College, Umm Al-Qura University (UQU)","correspondingAuthor":false,"prefix":"","firstName":"Fahd","middleName":"","lastName":"Almalki","suffix":""},{"id":432757621,"identity":"d80e98e1-cae9-4910-8c41-f78be1781958","order_by":3,"name":"Ibrahim Tawhari","email":"","orcid":"","institution":"Department of Internal Medicine, College of Medicine, King Khalid University","correspondingAuthor":false,"prefix":"","firstName":"Ibrahim","middleName":"","lastName":"Tawhari","suffix":""},{"id":432757622,"identity":"6c92c348-b27f-4c31-9ceb-099d9a639c7b","order_by":4,"name":"Mutlaq Alotaibi","email":"","orcid":"","institution":"Nephrology and Transplant Department, Alhada Armed Forced d Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mutlaq","middleName":"","lastName":"Alotaibi","suffix":""}],"badges":[],"createdAt":"2025-02-26 18:23:04","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6115444/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6115444/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":79662760,"identity":"d5997ba0-a125-47ac-94fc-67ca7a496beb","added_by":"auto","created_at":"2025-04-01 09:52:59","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":65083,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6115444/v1/f91cfffd4f3b495ce87e4d5f.jpg"},{"id":84497174,"identity":"fff5cfe5-63cf-4cc7-897c-f2f72baebc03","added_by":"auto","created_at":"2025-06-12 15:47:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":612091,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6115444/v1/3c2063c5-af83-4f41-ab23-cb556e41c925.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence of Glomerular Diseases in Saudi Arabia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eGlomerular diseases are a heterogeneous disorder of the glomeruli, the microscopic filtration units of the kidney. Disruption in the normal filtration process during these conditions result in proteinuria, hematuria, and finally progressive kidney dysfunction due to impaired renal function (Aslam et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Primary and secondary glomerular diseases are then differentiated by whether the disease relates to the kidney (primary) or results from some other systemic condition such as diabetes mellitus, autoimmune diseases, or chronic infections (secondary). The increasing prevalence of glomerular diseases all over the globe is attributed to the increased incidences of metabolic disorders, the change in lifestyle, and exposure to environmental factors (Mousa et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). This is also a concern in Saudi Arabia with high prevalence of diabetes, obesity and hypertension leading to increase in the chronic kidney disease (CKD) (Almalki et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe form of the epidemiology of glomerular diseases in Saudi Arabia has been influenced by genetic, environmental, and demographic factors. FSGS prevalence is said to be on the rise in the region, and has been linked to high rates of metabolic syndrome and obesity, both items of risk for glomerular (Assiry et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). IgA nephropathy (IgAN), the commonest cause of glomerulonephritis worldwide has been reported at a high rate in Saudi Arabia; but its exact prevalence is poorly documented because of the lack of renal biopsy data (Al-Shammari et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). In addition, genetic predisposition also plays a role as the Saudi population has high rates of consanguinity. Populations with frequent inter-family marriages, due to hereditary causes have heavier burden of glomerular diseases like inherited glomerular diseases Alport syndrome and familial FSGS (Al-Hamed et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDiabetic nephropathy is still the most common secondary glomerular disease in Saudi Arabia because of the prevalence of diabetes mellitus. It is reported by the World Health Organization (WHO) that Saudi Arabia has the world highest level of diabetes which exceeds 30 percent of adults (Alzahrani et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Diabetic nephropathy is responsible for more than 60% of end stage renal disease and dialysis dependency in Saudi Arabia accounting for nearly 40% of the diabetic patients (Safdar et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). As the disease impaires kidney function and increases the risk of cardiovascular morbidity and mortality to a significant extent (Almalki et al., 2018). Other common glomerular diseases, such as lupus nephritis, are frequently encountered in Saudi clinical settings where studies have reported a relatively high prevalence in the Saudi Arabian compared to the Western population (Naser et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). The patients with systemic lupus erythematosus (SLE) in Saudi Arabia exact the renal involvement most commonly worst requiring aggressive immunosuppressive therapy and long term management to prevent progression of CKD.\u003c/p\u003e \u003cp\u003eIn the kingdom of Saudi Arabia, glomerular disease burden is largely attributable to the infectious agent. The region is experienced by many patients with hepatitis B and C infections (both known to cause immune mediated glomerular injury), particularly those of the high risk groups. Chronic viral infections including hepatitides B and C can lead to membranous nephropathy and membranoproliferative glomerulonephritis and both of which are associated with persistent kidney damage and increased risk of ESRD (Alkhalifah et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Furthermore, some studies emerging evidence suggests that environmental toxins, prolonged use of nephrotoxic drugs (such as NSAIDs) and industrial pollutants have additive or predisposing role in the progression of glomerular disease, but further works in Saudi Arabia are still limited (AlMaawali et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGlomerular diseases represent a big clinical and public health burden in Saudi Arabia. Renal replacement therapies, including dialysis and kidney transplantation, are required and require costly therapy for patients with progress to CKD and ESRD as a result of glomerular disease. Glomerular diseases are a major underlying cause for renal failure in patients receiving dialysis depending on their renal function, so the demand for dialysis has risen steadily (Alshahrani et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). In addition CKD patients frequently suffer from reduced quality of life as a result of anemia, mineral bone disorders and cardiovascular disease, adding to the rates of hospitalization and healthcare expenditures (AlMaawali et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn spite of the high degree of glomerular disease burden, several challenges in diagnosis and treatment of glomerular diseases exist in Saudi Arabia. Not all healthcare facilities have either UNO renal biopsy available uniformly or have the capability of processing a renal biopsy specimen sufficiently to render a positive diagnosis in the majority of cases of glomerular disease (Al-Hamed et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). In many patients with early stage kidney disease, no symptoms arise and plenty has not been done with routine screening programs such as urine protein analysis and eGFR assessments in primary care settings. Moreover, patients are unaware of kidney disease even more so, which delayed medical attention and CKD progression into advanced stages (AlMaawali et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)..\u003c/p\u003e \u003cp\u003eAlthough these diseases are increasing in prevalence in Saudi Arabia, there is a need for enhanced epidemiological studies, national renal registries, as well as development of improved diagnostic tools. This will aid in the diagnosis, treatment and prevention of glomerular diseases in different demographic groups. In Saudi Arabia, diabetes, hypertension, and obesity are all increasing in weight and the incidence of glomerular diseases is expected to accumulate, which makes it necessary to take into account a comprehensive approach to public health to address this issue. The strengthening of nephrology services and increasing awareness among healthcare providers is a vital step for improvement. The implementation of early screening initiatives are also crucial in mitigating the impact of glomerular diseases and reducing their progression to ESRD.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study employs a systematic review research design to assess the prevalence of glomerular diseases in Saudi Arabia. The methodology follows rigorous epidemiological principles to ensure accurate data collection, analysis, and interpretation.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eLiterature Search Strategy\u003c/h2\u003e \u003cp\u003eA comprehensive literature search was conducted to evaluate the prevalence of glomerular diseases in Saudi Arabia. Major electronic databases, including PubMed, MEDLINE, Cochrane Library, and Google Scholar, were systematically searched to identify relevant studies. The search strategy was designed using a combination of Medical Subject Headings (MeSH) terms and Boolean operators (AND, OR) to ensure an extensive retrieval of studies. Keywords were selected based on their relevance to glomerular diseases and were categorized systematically, as presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eKeywords Used for Search Strategy\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKeywords and MeSH Terms\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlomerular Diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\"glomerulonephritis\", \"glomerular disease\", \"chronic kidney disease\", \"IgA nephropathy\", \"nephrotic syndrome\", \"focal segmental glomerulosclerosis\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevalence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\"epidemiology\", \"prevalence\", \"incidence\", \"population-based study\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSaudi Arabia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\"Saudi Arabia\", \"Middle East\", \"Arab population\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiagnostic Approaches\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\"renal biopsy\", \"immunofluorescence\", \"light microscopy\", \"electron microscopy\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRisk Factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\"diabetes mellitus\", \"hypertension\", \"autoimmune diseases\", \"genetic predisposition\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Selection Process\u003c/h3\u003e\n\u003cp\u003eThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for study selection to ensure transparency and reproducibility. The initial search yielded a broad range of articles, which were subsequently screened for eligibility based on predefined inclusion and exclusion criteria.\u003c/p\u003e\n\u003ch3\u003eInclusion Criteria:\u003c/h3\u003e\n\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eStudies reporting prevalence data of glomerular diseases in Saudi Arabia.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eCross-sectional, cohort, and retrospective studies published in peer-reviewed journals.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStudies conducted on human subjects with histopathological confirmation of glomerular disease.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eArticles published in English or with an available English translation.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e\n\u003ch3\u003eExclusion Criteria:\u003c/h3\u003e\n\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eCase reports, review articles, and editorials.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStudies focusing on non-Saudi populations or without specific regional data.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eArticles with insufficient or unclear methodology regarding disease classification.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e\n\u003ch3\u003eData Extraction and Management\u003c/h3\u003e\n\u003cp\u003eData from the included studies were extracted independently by two reviewers using a standardized data extraction form. Key variables included study design, sample size, patient demographics, diagnostic methods, and prevalence rates of specific glomerular diseases. Extracted data were recorded and managed using Microsoft Excel to ensure accuracy and facilitate the removal of duplicate records. By implementing this comprehensive methodological framework, the study aims to provide an accurate and detailed understanding of the prevalence of glomerular diseases in Saudi Arabia, offering insights for healthcare policy and management strategies.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Results And Discussion","content":"\u003cp\u003eIncluded studies demonstrated a significant finding in prevalence of glomerular diseases in Saudia Arabia population. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the characteristics of studies included in this research.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of Studies Included\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudy design\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eKey findings\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAl-Wakeel (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2016\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCross-sectional study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eComparison of estimated glomerular filtration rate (eGFR) using CKD-EPI and MDRD equations with GFR measured by inulin clearance in adult Saudi patients with CKD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCompared to inulin clearance, the CKD-EPI creatinine equation gave the most accurate eGFR with little bias and narrow limits of agreement. Other formulae underestimated GFR, including CKD-EPI cystatin C, creatinine-C, and MDRD. The prevalence of CKD in Saudi Arabia is mentioned as 5.7%.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBahrani et al. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCross-sectional study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe prevalence of CKD in type-2 diabetics in Al-Ahsa, Saudi Arabia, and associated risk factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCKD was identified in 41.1% of subjects, with 33.2% having mild to substantially reduced GFRs. Male patients had more reduced GFRs than females.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlshehri et al. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2025\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCross-sectional study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAssessment of the prevalence of CKD and associated risk factors across Saudi Arabia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe study found that CKD is a prevalent health issue in Saudi Arabia The overall prevalence of CKD was found to be 4.76%, with stage 3 CKD being the most common at 3.5%. The prevalence was higher among males (5.83%) compared to females (3.88%) and increased significantly with age, from 0.45% in individuals aged 18\u0026ndash;29 years to 50.94% in those aged 90 years or older.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlFaadhel et al. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2019\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMulticenter retrospective study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAnalysis of kidney biopsy data from multiple centers across Saudi Arabia over a 20-year period to determine the prevalence and trends of glomerular diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFSGS diagnoses increased and membranous nephropathy decreased over 20 years. The prevalence of diabetic nephropathy increased from 1.4% in the\u003c/p\u003e \u003cp\u003eFirst era to 10.2% in the last one.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlMatham et al. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2017\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetrospective study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStudy of 166 kidney biopsies from 2007 to 2016 at a Saudi tertiary referral center to determine glomerulonephritis prevalence and types.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrimary GN was detected in 61.4% of biopsies, with FSGS being the most prevalent subtype. Lupus nephritis, especially class IV, dominated 38.6% of secondary GN cases.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlhasan et al. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2020\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetrospective study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003erenal histopathology spectrum in children with kidney diseases in Saudi Arabia, 1998\u0026ndash;2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe findings revealed that secondary glomerulonephritis accounted for 42.3% of the cases, with lupus nephritis being the most common cause, noted in 20.7% of the cases. Among primary glomerular diseases, minimal change disease and focal segmental glomerulosclerosis were the most prevalent, together constituting 59% of the cases.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAl-Hussain et al. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2017\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetrospective study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAnalysis of renal biopsy specimens from crescent-detected glomerulonephritis patients to assess prevalence and kinds.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eImmune complex-mediated GN was the most common, accounting for 71.8% of cases, followed by pauci-immune GN at 20.5% and anti-glomerular basement membrane (GBM) antibody GN at 7.7%. The percentage of glomeruli with crescents varied among these types, with anti-GBM disease showing the highest mean at 93.3%, pauci-immune GN at 48.2%, and immune complex GN at 30.9%.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJalalah (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2020\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetrospective study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAnalyzing renal biopsy data from a single Saudi Arabian center over 10 years to determine glomerular disease trends.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMinimal change illness and postinfectious GN (PIGN) rose from 0% in period 1 to 6.5% in period 2. MCD fell from 13.5% in period 1 to 5.9% in period 2. For both eras, membrane GN is the most prevalent kind of GN, with comparable percentages (23.8% and 24.2%, respectively). The second condition in period 2 (23%), focal segmental glomerulosclerosis (FSGSC), is immunoglobulin In period 1, MCD is now ranked last rather than fourth, while nephropathy, with 9.6%, moved up to third place.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShawarby et al. (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2010\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetrospective study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAnalysis of data of patients with nephrotic syndrome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrimary glomerulonephritis comprised 80.3% of 233 renal biopsies, with minimal change glomerulopathy being the most frequent at 29.4%. Mesangioproliferative glomerulonephritis followed at 19.8%, and focal/segmental glomerulosclerosis at 15.5%. Lupus nephritis dominated secondary glomerulonephritis, representing 71.7% of that 19.7% subset. This data highlights a regional predominance of minimal change glomerulopathy and lupus nephritis, alongside a lower prevalence of membranoproliferative glomerulonephritis (9.6%).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMinshawy et al. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2014\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetrospective study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAnalysis of Tabuk ESRD patients' medical records to determine prevalence, causes, and outcomes.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDiabetic nephropathy and hypertension nephrosclerosis elevated ESRD in Tabuk. ESRD is rising in the region, hence the authors propose greater prevention and early detection.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe outrage of glomerular disease and chronic kidney disease (CKD) in Saudi Arabia has significantly evolved with time, impacted by changing epidemiological trends, technical advancement in diagnostics, and an elevating knowledge of risk factors. Studies in the country collect significant data about patterns of disease, gender prevalence, and effects of co-occurring conditions, all emphasizing the need for intense screening and preventive measures.\u003c/p\u003e \u003cp\u003eAmong these results, one of the important results is the overall inclined documentation for glomerular disease in Saudi Arabia including focal segmental glomerulosclerosis (FSGS). According to a research by AlFaadhel et al. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) of more than 1,000 biopsy proven, the most common glomerular pathology was FSGS, which is consonant with the explored research by AlMatham et al. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2017\u003c/span\u003e)). These outcomes investigated a declining trend in membranoproliferative and mesangioproliferative glomerulonephritis which may be because of the shift of the environmental and genetic factors or significant disease control.However, compared to RPGN, crescentic glomerulonephritis (CGN), a more important type of rapidly progressive glomerulonephritis (RPGN), is of relatively lesser prevalence but not negligible. Unlike Western populations, a prevalence of crescentic GN of 3.2% for renal biopsies (Mosaad et al.,2018). It further indicated the potential genetic and environmental triggers.\u003c/p\u003e \u003cp\u003eGender disparities in glomerular disease have been another region to be discussed. A higher frequency of kidney biopsies in male individuals is documented by most researches. Bakhit et al. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) attribute this to a greater number of comorbidities such as hypertension and diabetes among Saudi men. Some autoimmune-related nephropathies, like lupus nephritis, on the other hand, have a greater predilection among women. Alhasan et al. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) identified that more than 82% of the cases of systemic lupus erythematous (SLE)-associated nephritis were female, further supporting the widely documented link between lupus and female susceptibility. Diabetes continues to be one of the major risk factors for CKD and glomerulopathy in Saudi Arabia. Alwakeel et al. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2011\u003c/span\u003e) indicated that 31.8% of type 2 diabetes patients developed diabetic nephropathy (DN), with significant yearly GFR reduction. Al-Rubeaan et al. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) added more evidence from the SAUDI-DKD study that approximately 37% of cases of diabetic nephropathy progressed to end-stage renal disease (ESRD). Also, Alghaithi (2018) added that diabetes contributed more to CKD and ESRD in Saudi Arabia than it was earlier estimated, and females were more vulnerable.\u003c/p\u003e \u003cp\u003eThe precision of diagnostic equipment has been a primary area of research, especially for the evaluation of glomerular filtration rates (GFR). Al-Wakeel (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) focused on the value of the CKD-EPI creatinine formula in estimating GFR over other prognostic formulas, with special reference to Saudi populations. Bahrani et al. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) also outlined how obesity and hypertension affect decline in GFR, indicating the need for selective screening strategies within certain patient groups. Another critical research by Alshehri et al. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) gathered information from 42 diagnostic labs to emphasize the urge for large-scale screening and preventive measures. This national strategy would go on a higher scale toward early detection and disease control, specifically with the inclining burden of CKD in the origin.\u003c/p\u003e \u003cp\u003eThe primary rationale for CKD in Saudi Arabia have evolved over the years. Jalalah (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) documented an augment in post-infectious glomerulonephritis (PIGN) from 0\u0026ndash;6.5% over twenty years, whereas minimal change disease (MCD) rejected from 13.5\u0026ndash;5.9%. These changes may exhibit transformation infection trends, better antibiotic use, or genetic factors effecting disease exposure. Likewise, Minshawy et al. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) emphasized that hypertension and diabetes-related complications maintain primacy causes of ESRD, although a significant percentage of cases (33%) had unknown causes, warranting additional inquiry.\u003c/p\u003e\n\u003ch3\u003eImplications for Future Research and Clinical Practice\u003c/h3\u003e\n\u003cp\u003eConsolidated outcomes from these researches highlight the urgent need for determined changes to decrease the load of glomerular diseases and CKD in Saudi Arabia. Early detection, augmented especially in high-risk classes such as diabetics and hypertensive could have a profound impact on the course of disease. At the same time, the male and female gender stereotypes present us with the opportunity to address particularly personalized treatment of nephrology through the consideration of the specific risks presented in each gender. It is of paramount importance to the formation of more effective prevention and treatment ranges for the fact that current research is focusing on genetic predisposition, environmental factors, and the shifting disease trends. With application of these outcomes into the national health policy, Saudi Arabia will clearly improve renal health results and reduce the rising burden of CKD on the health care system.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eGlomerular diseases constitute a major public health problem in Saudi Arabia as they incipiently raise their incidence due to rise in the prevalence of diabetes, hypertension, obesity and genetic predispositions. The predominant principal of glomerular disease that manifested is focal segmental glomerulosclerosis (FSGS) while diabetic nephropathy and lupus nephritis are the commands diseases. She has also increased rates of kinship participates to hereditary glomerular disorders, such as Alport syndrome. The shifts in the disease trends revealed by epidemiological findings included increases in IgA nephropathy and diabetic nephropathy, and decreases in membranoproliferative glomerulonephritis. For example, diagnostic obstacles are preserved due to limited approach to renal biopsies, incongruous screening, and under diagnosis, particularly in asymptomatic early stages. ESRD is a disease that is becoming more burdensome with higher related healthcare costs pertaining to dialysis and transplantation. This emphasizes the need of additional effort in developing national registries, early detection programs and public guidance initiatives to improve early detection and administration. Integration of the effect of glomerular diseases in Saudi Arabia is reliant upon strengthening of nephrology services and adapting of preventive method aiming to metabolic and infectious risk factors.\u003c/p\u003e "},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eMEA: Write the main manuscript, review the manuscript LA: Write the main manuscript and review it FA: make the figures, tables and review the manuscript IT: Analyze and interpret the data, and review the article.MA: Write and review the main manuscript\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthics, Consent to Participate, and Consent to Publish declarations\u003c/strong\u003e: not applicable.\u003c/p\u003e\n\u003cp\u003eIf your study is a clinical trial, then please provide the necessary registration details (registry, trial registration number, and data of registration): The study is not a clinical trial. The manuscript type is a systematic review article. All the data used were referenced accordingly.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability declaration in the manuscript:\u003c/strong\u003e not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding declaration:\u003c/strong\u003e No funds\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAlFaadhel, T., Alsuwaida, A., Alsaad, K., Almezaini, L., Ahmed, N., AlHamad, M. Y., Bakheet, A., Wadera, J., Mokhtar, G., Alsuwaida, F., Siddiqui, R., Kechrid, M., Abdelrehman, A., Husain, S., Kfoury, H., Alabdulsalam, A., Alanazi, M., Oudah, N. A., \u0026amp; AlHozali, H. (2019). Prevalence and 20-year epidemiological trends of glomerular diseases in the adult Saudi population: a multicenter study. \u003cem\u003eAnnals of Saudi Medicine\u003c/em\u003e, \u003cem\u003e39\u003c/em\u003e(3), 155\u0026ndash;161. https://doi.org/10.5144/0256-4947.2019.155\u003c/li\u003e\n\u003cli\u003eAlghaithi, M. F. a. a. I. B. S. M. a. M. S. T. a. 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A., Elfaki, I., \u0026amp; Hawsawi, Y. M. (2022). Identification and characterization of novel mutations in chronic kidney disease (CKD) and autosomal Dominant polycystic kidney Disease (ADPKD) in Saudi subjects by Whole-Exome sequencing. \u003cem\u003eMedicina\u003c/em\u003e, \u003cem\u003e58\u003c/em\u003e(11), 1657. https://doi.org/10.3390/medicina58111657\u003c/li\u003e\n\u003cli\u003eAslam, N., Khawaja, N., Nawaz, Z., Mushtaq, F., Mousa, D., Rehman, E., \u0026amp; Sulaiman, M. (2013). Pattern of glomerular disease in the Saudi population: A single-center, five-year retrospective study. \u003cem\u003eSaudi Journal of Kidney Diseases and Transplantation\u003c/em\u003e, \u003cem\u003e24\u003c/em\u003e(6), 1265. https://doi.org/10.4103/1319-2442.121288\u003c/li\u003e\n\u003cli\u003eAssiry, A., Alshahrani, S., Banji, D., Banji, O. J. F., Syed, N. K., \u0026amp; Alqahtani, S. S. (2022). 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S., \u0026amp; Safdar, O. Y. (2018). Assessment of the etiologies and renal outcomes of rapidly progressive glomerulonephritis in pediatric patients at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. \u003cem\u003eSaudi Medical Journal\u003c/em\u003e, \u003cem\u003e39\u003c/em\u003e(4), 354\u0026ndash;360. https://doi.org/10.15537/smj.2018.4.21366\u003c/li\u003e\n\u003cli\u003eMousa, D., Alharbi, A., Helal, I., Al-Homrany, M., Alhujaili, F., Alhweish, A., Marie, M. A., \u0026amp; Sayyari, A. A. (2021). Prevalence and Associated Factors of Chronic Kidney Disease among Relatives of Hemodialysis Patients in Saudi Arabia. \u003cem\u003eKidney International Reports\u003c/em\u003e, \u003cem\u003e6\u003c/em\u003e(3), 817\u0026ndash;820. https://doi.org/10.1016/j.ekir.2020.12.029\u003c/li\u003e\n\u003cli\u003eNaser, A. Y., Alwafi, H., Alotaibi, B., Salawati, E., Samannodi, M., Alsairafi, Z., Alanazi, A. F. R., \u0026amp; Dairi, M. S. (2021). 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A clinicopathologic study of glomerular disease: experience of the King Fahd Hospital of the University, Eastern Province, Saudi Arabia. \u003cem\u003eHong Kong Journal of Nephrology\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e(1), 20-30. http://dx.doi.org/10.1016/S1561-5413(10)60005-1 \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Glomerular disease, chronic kidney disease, Saudi Arabia, renal biopsy, nephropathy, epidemiology","lastPublishedDoi":"10.21203/rs.3.rs-6115444/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6115444/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction: \u003c/strong\u003eGlomerular diseases are marked as a significant public health concern across Saudi Arabia. The prevalence of these diseases keeps on evolving with increased patterns which is influenced by demographic shifts, comorbid conditions, and advancements in diagnostic methods. This study examines the prevalence and distribution of glomerular diseases in Saudi Arabia.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A systematic review of was conducted using PRISMA methodology and research articles were analyzed and assessed on a preestablished screening criteria.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The prevalence of CKD in Saudi Arabia ranges from 4.76% to 5.7%, with focal segmental glomerulosclerosis (FSGS) being the most commonly diagnosed primary glomerular disease. The diabetic nephropathy is a leading cause of CKD and end-stage renal disease (ESRD) which indicated increased incidence among type 2 diabetes patients. The gender differences were also observed with males showing elevated CKD prevalence. It was also found that lupus nephritis was more prevalent in females.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Glomerular diseases in Saudi Arabia are surging necessitating early screening and improved diagnostic strategies. The targeted interventions to mitigate disease progression are also recommended for future researches and medical interventions.\u003c/p\u003e","manuscriptTitle":"Prevalence of Glomerular Diseases in Saudi Arabia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-01 09:52:54","doi":"10.21203/rs.3.rs-6115444/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"baefa0ac-c2d7-44b5-bbe7-25603eb11659","owner":[],"postedDate":"April 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-12T15:38:52+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-01 09:52:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6115444","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6115444","identity":"rs-6115444","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}