DR JANICE KRISHNA1, DR ZAYNAH KHAN2, DR YOGESHNI CHANDRA2, A/PROF SIVASELVAM SIVAKUMAR3, PROF SHILPANJALI JESUDASON4, A/PROF ANGUS RITCHIE5, DR ANIS TA'EED1
1Department of Internal Medicine, Colonial War Memorial Hospital, Suva, Fiji, 2Department of Internal Medicine, Lautoka Hospital, Lautoka, Fiji, 3School of Medical Sciences, Fiji National University, Suva, Fiji, 4Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia, 5Renal Unit, Concord Repatriation General Hospital, Concord, Australia
Biography:
Clinical Associate Professor Angus Ritchie is a Senior Staff Specialist Nephrologist at Concord Repatriation General Hospital and the Chief Medical Information Officer for Sydney Local Health District. He managed a 6 year International Society of Nephrology Sister Renal Centre Partnership with Fiji, which has now become a Trio to include Port Moresby General Hospital, PNG.
Aim:
This retrospective study aims to explore the incidence, distribution and patterns of biopsy-proven glomerulonephritis (GN) in Fiji for the first time.
Background:
Fiji has a reported high age-adjusted incidence of kidney failure between 753 and 938 per million population. A comprehensive understanding of the underlying diseases causing kidney failure in Fiji, including GN, is important to improve outcomes.
Methods:
All native kidney biopsies conducted in Fiji’s public sector from 2019 and 2023 were included in the annual crude biopsy and complication rate. Non-diagnostic, non-glomerular pathology and repeat biopsies were excluded from further evaluation.
Results:
142 native kidney biopsies yielded an annual crude biopsy rate of 31.6 per million population. After exclusions, 121 glomerulonephritis cases were evaluated with a median age of 33.5 years (range 10-76), female predominance (66.1%), median eGFR 44ml/min/1.73m2 (IQR 21-88) and median proteinuria of 3.0g/day (IQR 1.1-4.6). Most biopsies (88.4%) were evaluated with light microscopy alone. Nephrotic syndrome was the leading biopsy indication (38.8%) across all ages and sexes, followed by undefined kidney impairment (24.8%), nephritic syndrome (19%) and isolated urinary abnormalities (17.4%). Lupus nephritis (43%), diabetic nephropathy (19%), unspecified GN (16.5%) and focal segmental glomerulosclerosis (8.3%) were the most common histopathological findings. Significant complications occurred in seven patients (4.9%).
Conclusions:
Developing kidney biopsy services in Fiji are providing insights into GN patterns in a Pacific Island country for the first time. Although true disease prevalence cannot be ascertained from this study due to study and diagnostic limitations, our results raise the possibility that certain GN have low prevalence in Fiji. Our study highlights an opportunity for investment in training and equipment to enhance GN understanding in Fiji, and the region.