Epidemiologia das Glomerulopatias no Maranhão - Nordeste brasileiro - e criação de uma ferramenta para um registro nacional

Abstract

Introduction: Glomerulopathies are pathologies with low incidence and prevalence and high morbidity and mortality, being associated with the progression of chronic kidney disease and with death. Different incidence rates are influenced by epidemiological and socioeconomic aspects. Maranhão, a Brazilian state with a tropical climate, has 76% of its population of blacks and mulattoes, with 54.1% of its population living below the poverty line. Due to the peculiarities of this state, we will describe the social and epidemiological characteristics of glomerulopathies in this population and present a software created to request the renal biopsies in a service that is a reference in renal pathology for several federal hospitals in the country. Materials and methods: Initially, a retrospective study was conducted with a survey of the histopathological findings of native kidneys in the Laboratory of Immunofluorescence and Electronic Microscopy (LIEM) of the Brazilian Hospital Services Company (EBSERH) from January 2008 to December 2017. Subsequently, the development of a computational tool for requesting renal biopsy for the EBSERH national network. Results: In this study, 654 cases were analyzed. There was a slight predominance of females (54.28%) and mean age of 31.65  17.78 years. Among the 518 patients with per capita income data, 341 (52.14%) received <½ minimum wage. Nephrotic syndrome (NS) was the most frequent clinical indication in all age groups. Lupus nephritis (LN) was the most prevalent pathology with 162 cases (24.77%), followed by segmental and focal glomerulosclerosis (FSGS) with 140 cases (21.41%) and membranous glomerulopathy (MG) with 93 cases 14.22%). Infection, diabetic nephropathy (DN) and IgA nephropathy (IgAN) had a low incidence, 36 (5.5%), 22 (3.36%); 21 (3.21%) cases, respectively. In January 2019, the computational tool for requesting renal biopsy was released for internal use of HUUFMA and in February 2019 it was made available to the other hospitals of the EBSERH network. Conclusion: NS was the most frequent clinical indication in patients with glomerulopathies. LN was the most prevalent pathology in women; the most common FSGS in men and children/adolescent. Infection, DN and IgAN had low prevalence. Half of the patients with glomerulopathies undergoing renal biopsy in HUUFMA are below the poverty line. To characterize a society regarding its epidemiological profile facilitates clinical reasoning and brings data for comparison with other regions and a better understanding of its frequency. Thus, the computational tool developed in this study will facilitate the data collection and help the pathologist to make the diagnosis and it will serve as the basis for the creation of a national registry.