Incidence of glomerulonephritis and non-diabetic end-stage renal disease in a developing middle-east region near armed conflict.

BACKGROUND: Estimates of the incidence of glomerulonephritis (GN) and end-stage renal disease (ESRD) in an Iraqi population are compared with the United States (US) and Jordan. METHODS: The study set consist of renal biopsies performed in 2012 and 2013 in the Kurdish provinces of Northern Iraq. The age specific and age standardized incidence of GN was calculated from the 2011 population. ESRD incidence was estimated from Sulaimaniyah dialysis center records of patient's inititating hemodialysis in 2017. RESULTS: At an annual biopsy rate of 7.8 per 100,000 persons in the Kurdish region, the number of diagnoses (2 years), the average age of diagnosis, and annual age standardized incidence (ASI)/100,000 for focal segmental glomerulosclerosis (FSGS) was n = 135, 27.3 ± 17.6 years, ASI = 1.6; and for all glomerulonephritis (GN) was n = 384, 30.4 ± 17.0 years, ASI = 5.1. FSGS represented 35% of GN biopsies, membranous glomerulonephritis 18%, systemic lupus erythematosus 13%, and immunoglobulin A nephropathy 7%. For FSGS and all GN, the peak age of diagnoses was 35-44 years of age with age specific rates declining after age 45. The unadjusted annual ESRD rate was 60 per million with an age specific peak at 55-64 years and a decline after age 65. The assigned cause of ESRD was 23% diabetes, 18% hypertension, and 12% GN with FSGS comprising 41% of biopsy-diagnosed, non-diabetic ESRD. CONCLUSIONS: The regional incidence of ESRD in Northern Iraq is much lower than the crude incidences of 100 and 390 per million for Jordan and the US respectively. This is associated with low renal disease rates in the Iraqi elderly and an apparent major contribution of FSGS to ESRD.

Characteristics of kidney transplantation in baghdad: an epidemiological study.

Kidney transplantation remains the optimal therapy for patients with end-stage renal failure. The kidney transplantation program in Iraq has finished its third decade, and this study was performed to assess the characteristics of this program. This study was performed, from early 2004 to mid-2005, on all patients who underwent renal transplantation and were residing in Baghdad. All the subjects were subjected to full examination and detailed investigations at the Al-Karamah Hospital, Baghdad. A total of 512 patients (males, 69.7%), all of whom were residing in Baghdad, underwent kidney transplantation from 1979 to 2005. The donor source was living donors in 55.7% of these patients, living unrelated donors in 42.6% and emotionally related donors in 1.7%. The recipients' age range was from 7 to 64 years with a mean age of 41 years. The patient survival rates at 6, 12 and 18 months were 91, 91 and 89% respectively, while the graft survival rates in the same periods were 89, 89 and 82% respectively. The annual incidence of renal transplant in our study was 15.4 per million people. About 55% of the transplants were performed in private hospitals and 41% in Government hospitals; the others (3.5%) were performed abroad. We conclude that this study is an initial step to assess the renal transplant activities in Iraq, and we hope that this will act as a launching pad for future studies.

Successful pregnancy in a patient with hemodialysis in Iraq.

An 18-year-old woman patient was discovered to have severe anemia and advanced renal failure during a routine prenatal follow-up at her 6th week of gestation. During the first few weeks of therapy, the hemodialysis frequency was increased gradually and Erythropoietin was administered with intravenous iron therapy to keep the patient's hemoglobin above 115 gm/L. Blood pressure rose was controlled by alpha methyldopa. Obstetric follow-up consisted of monitoring the fetal activity and growth, placental maturity and umbilical artery perfusion. On the 32nd week of gestation, the patient had a normal vaginal delivery of live female weighing 2,100 gm. the patient had a completely uneventful postpartum course and the newborn baby was well. In conclusion, our index case illustrates that intensified dialysis regimens and attentive medical care results in a successful outcome of pregnancy in patients with end stage renal disease on hemodialysis.