Correspondence

The Nephrotic Syndrome in the Democratic Republic of Congo

N Engl J Med 2006; 354:1085-1086March 9, 2006

Article

To the Editor:

In some parts of Africa, the hospital admission rate for the nephrotic syndrome is 100 times greater than that in the United Kingdom, Europe, or the United States.1 In the Democratic Republic of Congo, the nephrotic syndrome accounts for 38 percent of admissions in the nephrology department. During the 1970s, minimal-change glomerulopathy responsive to corticosteroids2 represented 22 percent of renal admissions. The remaining 78 percent consisted of diverse glomerular abnormalities, such as amyloidosis, membranoproliferative and proliferative glomerulonephritis, and membranous glomerulopathy. Of interest in this discussion, focal segmental glomerulosclerosis represented only 6 percent of these cases. Overall, 52 percent of cases of the nephrotic syndrome were associated with chronic parasitic or infectious diseases — malaria, trypanosomiasis, schistosomiasis, filariasis, tuberculosis, and leprosy — and were classified as secondary glomerulonephritis.

During the 1980s, the incidence of focal segmental glomerulosclerosis rose to 41 percent from 6 percent,3 and the lesion encompassed all variants of focal segmental glomerulosclerosis, including so-called collapsing and human immunodeficiency virus (HIV)–associated nephropathy, although specific information about HIV status was not known in most patients. Focal segmental glomerulosclerosis remained the leading cause of the nephrotic syndrome in a series from the 1990s, with HIV accounting for 30 percent of cases; the remainder of the cases were idiopathic.4 Well-acknowledged challenges in emerging countries are methods of a single cause to glomerulonephritis and the use of renal biopsy in arriving at a correct diagnosis.1 The decline of parasitic causes of the nephrotic syndrome since the 1970s was apparently associated with sustained colonial and postcolonial eradication campaigns. Multiple coexisting conditions and new viral diseases like HIV and AIDS also account for these changes in the cause of focal segmental glomerulosclerosis.

Each year in the tropics, end-stage renal disease (ESRD) owing to glomerulonephritis develops in nearly 100 young adults per 1 million population.5 It is probable that the current resurgence of leprosy, trypanosomiasis, filariasis, and schistosomiasis and the increased burden of diabetes, malaria, tuberculosis, HIV and AIDS, and sustained poverty in the war-devastated Democratic Republic of Congo will result in an explosion in the number of cases of the nephrotic syndrome and ESRD in the near future. Our recent data from 2001 to 2004 indicate an overwhelming increase in admissions for chronic kidney disease among young adults in Kinshasa. Seventy-eight percent presented at a late stage of the disease requiring renal-replacement therapy, which is unavailable in this country. To save lives, international awareness and assistance are urgently needed. These endemic diseases and the problems of low socioeconomic status, a lack of education, and poor nutrition and sanitation need to be taken into account in designing ways to alleviate the high mortality and morbidity of renal disease in tropical Africa.

Nestor M. Pakasa, M.D., Ph.D.
Centre Hospitalier Universitaire, 42055 Saint Etienne CEDEX 02, France
pakasan@wanadoo.fr

Ernest K. Sumaili, M.D.
Cliniques Universitaires, Kinshasa XI, Democratic Republic of Congo

5 References

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Citing Articles (3)

Citing Articles

1. 1

   Nestor-M. Pakasa, Ernest-K. Sumaïli. (2011) Particularités anatomopathologiques de la maladie rénale du sujet de l’Afrique sub-Saharienne : revue synthétique des données de la République démocratique du Congo. Annales de Pathologie
   CrossRef

2. 2

   E. K. Sumaili, J.-M. Krzesinski, C. V. Zinga, E. P. Cohen, P. Delanaye, S. M. Munyanga, N. M. Nseka. (2008) Prevalence of chronic kidney disease in Kinshasa: results of a pilot study from the Democratic Republic of Congo. Nephrology Dialysis Transplantation 24:1, 117-122
   CrossRef

3. 3

   A Walker, J Ellis, M Irama, J Senkungu, D Nansera, J Axton, R J Coward, D S Peat, H H Bode, P W Mathieson. (2007) Eosinophilic glomerulonephritis in children in Southwestern Uganda. Kidney International 71:6, 569-573
   CrossRef