Global Disease Burden From Acute Glomerulonephritis 1990–2019

Abstract

Acute glomerulonephritis (GN) is an acute episode of glomerular injury accompanied by inflammation, usually characterizing by edema, hematuria, hypertension, and acute kidney injury.1Vinen C.S. Oliveira D.B.G. Acute glomerulonephritis.Postgrad Med J. 2003; 79 (quiz 212–213): 206-213Crossref PubMed Scopus (23) Google Scholar In the classification of the clinical renal presentation, acute GN (International Classification of Diseases code: N00-N01.9) (Table S1) generally includes nephritic syndrome and rapidly progressive GN.1Vinen C.S. Oliveira D.B.G. Acute glomerulonephritis.Postgrad Med J. 2003; 79 (quiz 212–213): 206-213Crossref PubMed Scopus (23) Google Scholar The clinical outcome of patients with acute GN depends on the disease severity and the underlying cause. Acute post-infectious glomerulonephritis is the most common form of acute GN, particularly in children. Viral, bacterial, and protozoal organisms can cause infections, with subsequent acute post-infectious glomerulonephritis.2Prasad N. Patel M.R. Infection-induced kidney diseases.Front Med. 2018; 5: 327Crossref Scopus (12) Google Scholar With the aging population growing, acute GN is increasingly common in older patients due to the increased rates of endocarditis, which is associated with the ongoing utility of intravenous drugs and cardiac devices.3Boils C.L. Nasr S.H. Walker P.D. et al.Update on endocarditis-associated glomerulonephritis.Kidney Int. 2015; 87: 1241-1249Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar Thus, not only younger children but also older adults are affected by this disease. In addition to acute post-infectious glomerulonephritis, the other forms of acute GN include immunoglobulin A nephropathy and rapidly progressive GN.1Vinen C.S. Oliveira D.B.G. Acute glomerulonephritis.Postgrad Med J. 2003; 79 (quiz 212–213): 206-213Crossref PubMed Scopus (23) Google Scholar Immunoglobulin A nephropathy is characterized by a mesangial proliferative GN. Rapidly progressive GN has the potential to destroy renal function within days. These forms of acute GN usually cannot be expected to resolve spontaneously.1Vinen C.S. Oliveira D.B.G. Acute glomerulonephritis.Postgrad Med J. 2003; 79 (quiz 212–213): 206-213Crossref PubMed Scopus (23) Google Scholar Acute GN can result in acute renal failure requiring dialysis and intensive care and results in economic costs to families and the health system. Therefore, we do not turn a blind eye to the disease burden of acute GN. Previous predominantly single-center studies have described the clinical characteristics, complications, and clinical outcome of adults and children with acute GN.4Eison T.M. Ault B.H. Jones D.P. et al.Post-streptococcal acute glomerulonephritis in children: clinical features and pathogenesis.Pediatr Nephrol. 2011; 26: 165-180Crossref PubMed Scopus (88) Google Scholar,5Dowler J. Wilson A. Acute post-streptococcal glomerulonephritis in Central Australia.Australian J Rural Health. 2020; 28: 74-80Crossref PubMed Scopus (2) Google Scholar However, a large-scale systematic analysis of the global disease burden of acute GN is lacking. The Global Burden of Disease (GBD) Study 2019 provides up-to-date data regarding the epidemiology of acute GN for 195 countries and territories from 1990 to 2019.6Diseases G.B.D. Injuries C. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019.Lancet. 2020; 396: 1204-1222Abstract Full Text Full Text PDF PubMed Scopus (541) Google Scholar Using this data source, we analyzed rates in 2019, and temporal trends between 1990 and 2019, for the point prevalence, incidence, disability-adjusted life-years (DALYs), and mortality (Table S2) associated with acute GN at a global, regional, and national level. Globally, there were 48,375 point prevalent cases, 722,244 incident cases, 10,522 deaths, and 307,480 DALYs attributed to acute GN in 2019. The age-standardized rates in 2019 for prevalence per 100,000 population were 0.63 (95% uncertainty interval [UI], 0.52 to 0.76), for incidence was 9.45 (95% UI, 7.72 to 11.55), the mortality rate was 0.13 (95% UI, 0.10 to 0.16), and the DALY rate was 3.90 (95% UI, 2.57 to 4.61) (Table 1). The highest age-standardized rates were in North Korea (1.75; 95% UI, 1.27 to 2.32) for prevalence, in Vietnam (25.44; 95% UI, 19.32 to 32.90) for incidence, in China (0.40; 95% UI, 0.27 to 0.46) for mortality, and in Timor-Leste (21.70; 95% UI, 8.04 to 32.32) for DALYs (rate per 100,000 population in 2019) (Table 1, Figure 1). These rates decreased significantly from 1990 to 2019 per year. Generally, East Asia had the highest decreased trend of age-standardized prevalence and age-standardized incidence rate during 1990 to 2019, respectively. Eastern Europe had the highest decreased trend of age-standardized mortality and age-standardized DALYs over the same period. By contrast, the highest increased trend in age-standardized incidence and age-standardized prevalence rate was in South Asia. At the same time, North Africa and Middle East, High-income North America, and Central Latin America had the highest increased trends of age-standardized mortality and age-standardized DALYs from 1990 to 2019 (Table 1, Figure S1). The national age-standardized rates and trends of prevalence, incidence, mortality, and DALYs across the 195 countries and territories were seen in Table S3. Here, we found the highest disease burden in Asian countries, particularly in Brunei, Uzbekistan, Vietnam, and North Korea with the highest prevalence and incidence, and in China, Laos, Afghanistan, North Korea, and Cambodia with the highest mortality and DALYs.Table 1Numbers, age-standardized rates of prevalence, incidence, mortality, and disability-adjusted life years from acute glomerulonephritis in 2019, and trends from 1990 to 2019 in the global and regional levelsVariablesPrevalenceCount (IQR)Age-standardized prevalence (95% UI)Annual percent change in rate (CI)aPercent change in rate refer to average annual percent changes between 1990 and 2019.Prevalence Global level48,375 (39,386, 58,295)0.63 (0.52 to 0.76)-1.92 (-2.14, -1.69) Male25,791 (21,044, 31,044)0.67 (0.55 to 0.8)-2.02 (-2.26, -1.78) Female22,583 (18,339, 27,267)0.60 (0.48 to 0.72)-1.81 (-2.02, -1.6) Regional levelLow SDI6196 (4870, 7745)0.55 (0.45 to 0.67)0.54 (0.43, 0.66)Low-middle SDI13,997 (11,377, 16,925)0.78 (0.64 to 0.93)-0.1 (-0.18, -0.02)Middle SDI15,894 (12903,19163)0.69 (0.56 to 0.83)-2.75 (-3.12, -2.37)High-middle SDI8427 (6902, 10,229)0.62 (0.5 to 0.75)-3.28 (-3.66, -2.9)High SDI3832 (3121, 4605)0.41 (0.32 to 0.5)-0.74 (-0.8, -0.68) Andean Latin America202 (154, 259)0.32 (0.24 to 0.41)0.24 (0.11, 0.37) Australasia93 (69, 120)0.35 (0.25 to 0.47)-0.02 (-0.07, 0.04) Caribbean279 (207, 363)0.6 (0.44 to 0.78)0.18 (0.15, 0.2) Central Asia1377 (1078, 1753)1.45 (1.14 to 1.84)-0.46 (-0.64, -0.28) Central Europe936 (753, 1150)0.94 (0.74 to 1.18)-0.18 (-0.28, -0.08) Central Latin America1166(904,1468)0.48 (0.37 to 0.6)-0.24 (-0.4, -0.07) Central sub-Saharan Africa590 (425, 776)0.49 (0.37 to 0.63)-0.04 (-0.1, 0.02) East Asia6805 (5516, 8513)0.53 (0.42 to 0.66)-5.34 (-6.1, -4.58) Eastern Europe2876 (2412, 3448)1.3 (1.09 to 1.55)-1.62 (-1.86, -1.38) Eastern sub-Saharan Africa2144 (1641, 2738)0.54 (0.43 to 0.67)-0.11 (-0.16, -0.05) High-income Asia Pacific1939 (1558, 2345)1.41 (1.08 to 1.80)0.27 (0.21, 0.33) High-income North America526 (457, 600)0.12 (0.10 to 0.14)-0.32 (-0.49, -0.14) North Africa and Middle East2683 (2092, 3415)0.46 (0.36 to 0.58)0.96 (0.91, 1.01) Oceania128 (91, 174)0.91 (0.67 to 1.19)0.21 (0.17, 0.25) South Asia14,564 (11,840, 17,670)0.78 (0.64 to 0.94)1.75 (1.44, 2.07) Southeast Asia6790 (5344, 8557)1.05 (0.83 to 1.34)-0.85 (-0.95, -0.74) Southern Latin America131 (97, 174)0.19 (0.14 to 0.26)0.01 (-0.13, 0.16) Southern sub-Saharan Africa398 (321, 489)0.5 (0.41 to 0.61)0.09 (0.04, 0.14) Tropical Latin America2889 (2385, 3516)1.43 (1.17 to 1.78)-1.14 (-1.32, -0.97) Western Europe682 (535, 853)0.17 (0.13 to 0.22)0.01 (-0.07, 0.1) Western sub-Saharan Africa1176 (886, 1497)0.26 (0.2 to 0.32)0.26 (0.19, 0.32)Incidence Global level722,244 (595,182, 877,834)9.45 (7.72 to 11.55)-1.84 (-2.05, -1.62) Male384,881 (317,618, 466,573)10 (8.23 to 12.16)-1.94 (-2.17,-1.71) Female337,363 (277,087, 410,579)8.91 (7.23 to 10.9)-1.72 (-1.93 ,-1.52) Regional levelLow SDI90,785 (71,609, 113,621)8.13 (6.57 to 9.93)0.53 (0.39, 0.68)Low-middle SDI209,162 (171,704, 254,192)11.71 (9.67 to 14.18)-0.04 (-0.12, 0.05)Middle SDI229,525 (188,587, 279,710)9.96 (8.15 to 12.2)-2.49 (-2.81, -2.17)High-middle SDI124,479 (102,778, 150,652)9.13 (7.41 to 11.24)-3.23 (-3.61, -2.86)High SDI56,795 (47,068, 68,265)6.00 (4.78 to 7.51)-0.75 (-0.81, -0.68) Andean Latin America3034 (2312, 3921)4.79 (3.65 to 6.18)0.25 (0.12, 0.38) Australasia1368 (1037, 1770)5.15 (3.79 to 6.85)-0.03 (-0.09, 0.03) Caribbean4196 (3119, 5510)9.01 (6.67 to 11.88)0.16 (0.14, 0.19) Central Asia20,600 (16,148, 26,447)21.67 (16.95 to 27.73)-0.39 (-0.55, -0.23) Central Europe13,940 (11,329, 17,197)13.98 (11.1 to 17.69)-0.18 (-0.27, -0.08) Central Latin America17,472 (13,693, 22,068)7.17 (5.63 to 9.05)-0.27 (-0.43, -0.11) Central sub-Saharan Africa8854 (6432, 11,696)7.46 (5.69 to 9.59)0 (-0.06, 0.05) East Asia97,614 (79,539, 119,180)7.65 (6.16 to 9.4)-5.34 (-6.1, -4.57) Eastern Europe43,027 (36,442, 51,278)19.53 (16.55 to 23.27)-1.5 (-1.73, -1.27) Eastern sub-Saharan Africa32,783 (25,239, 41,795)8.31 (6.66 to 10.38)-0.12 (-0.17, -0.06) High-income Asia Pacific28,660 (23,389, 34,876)20.76 (16.04 to 26.93)0.26 (0.2, 0.32) High-income North America7723 (6781, 8749)1.76 (1.56 to 2)-0.36 (-0.53, -0.2) North Africa and Middle East39,991 (31,202, 51,879)6.88 (5.4 to 8.72)0.92 (0.87, 0.96) Oceania1938 (1400, 2654)13.73 (10.09 to 18.28)0.2 (0.16, 0.24) South Asia220,143 (180,802, 265,753)11.86 (9.88 to 14.25)1.72 (1.4, 2.04) Southeast Asia101,025 (79,100, 129,176)15.73 (12.31 to 20.21)-0.82 (-0.92, -0.72) Southern Latin America1969 (1479, 2559)2.87 (2.15 to 3.79)0 (-0.15, 0.15) Southern sub-Saharan Africa6005 (4851, 7402)7.56 (6.2 to 9.27)0.1 (0.05, 0.15) Tropical Latin America43,849 (36,483, 52,981)21.8 (17.88 to 26.71)-1.11 (-1.28, -0.93) Western Europe10,091 (8034, 12,503)2.55 (1.99 to 3.28)0 (-0.09, 0.08) Western sub-Saharan Africa17,961 (13,753, 22,763)3.93 (3.11 to 4.9)0.23 (0.17, 0.29)Mortality Global level10,522 (7199, 12,200)0.13 (0.09 to 0.15)-2.89 (-3.15, -2.63) Male5670 (2969, 6847)0.16 (0.08 to 0.19)-2.67 (-2.96, -2.38) Female4853 (3784, 5980)0.11 (0.09 to 0.14)-3.17 (-3.4, -2.94) Regional levelLow SDI548 (153, 1053)0.08 (0.02 to 0.18)-2.1 (-2.19, -2.02)Low-middle SDI1971 (1010, 2297)0.15 (0.08 to 0.18)-2.86 (-3.01, -2.7)Middle SDI5502 (3660, 6453)0.24 (0.17 to 0.29)-2.86 (-3.18, -2.55)High-middle SDI1945 (1539, 2256)0.1 (0.08 to 0.12)-4.07 (-4.37, -3.77)High SDI554 (476, 606)0.03 (0.02 to 0.03)-0.02 (-1.15, 1.1) Andean Latin America8 (6, 11)0.02 (0.01 to 0.02)-5.41 (-6.06, -4.75) Australasia7 (6, 9)0.01 (0.01 to 0.02)-0.65 (-3.21, 1.91) Caribbean17 (10, 27)0.04 (0.02 to 0.06)-1.42 (-1.99, -0.85) Central Asia110 (93, 134)0.12 (0.1 to 0.15)-3.79 (-4.55, -3.03) Central Europe41 (35, 47)0.02 (0.02 to 0.02)-5.18 (-6.2, -4.16) Central Latin America281 (242, 320)0.12 (0.11 to 0.14)3.2 (0.57, 5.84) Central sub-Saharan Africa110 (30, 221)0.18 (0.04,0.41)-1.33 (-1.62, -1.05) East Asia7175 (4789, 8407)0.39 (0.27 to 0.45)-3.24 (-3.5, -2.97) Eastern Europe156 (132, 182)0.05 (0.05 to 0.06)-7.86 (-8.72, -7) Eastern sub-Saharan Africa317 (76, 761)0.15 (0.03 to 0.41)-2.74 (-2.83, -2.65) High-income Asia Pacific151 (119, 172)0.03 (0.02 to 0.03)-1.52 (-1.75, -1.29) High-income North America269(236,297)0.04 (0.04 to 0.04)2.99 (0.25, 5.73) North Africa and Middle East424 (58, 528)0.1 (0.02 to 0.12)3.17 (2.66, 3.69) Oceania4 (1, 8)0.04 (0.01 to 0.08)0.04 (-0.18, 0.25) South Asia171 (124, 226)0.01 (0.01 to 0.02)-3.9 (-4.06, -3.74) Southeast Asia1060 (311, 1464)0.19 (0.06 to 0.26)-3.17 (-3.28, -3.05) Southern Latin America3 (2, 3)0.003 (0.0029 to 0.004)-3.56 (-4.75, -2.38) Southern sub-Saharan Africa35 (30, 41)0.06 (0.05 to 0.06)-0.69 (-0.98, -0.39) Tropical Latin America58 (53, 63)0.03 (0.02 to 0.03)-6.15 (-6.71, -5.59) Western Europe92 (80, 101)0.0087 (0.008 to 0.009)-1.18 (-3, 0.65) Western sub-Saharan Africa34 (12, 63)0.01 (0 to 0.02)-1.94 (-2.13, -1.75)DALYs Global level307,480 (204,185, 362,573)3.90 (2.57 to 4.61)-3.89 (-4.08, -3.7) Male168,933 (84,118, 207,613)4.39 (2.18 to 5.36)-3.59 (-3.81, -3.36) Female138,547 (94,777, 178,442)3.46 (2.29 to 4.5)-4.24 (-4.38, -4.09) Regional levelLow SDI27,352 (8248, 47,095)2.67 (0.77 to 5.1)-2.7 (-2.77, -2.63)Low-middle SDI62,601 (31,604, 74,473)4.05 (2.05 to 4.79)-3.96 (-4.09, -3.83)Middle SDI158,186 (102,853, 185,699)6.61 (4.28 to 7.72)-3.77 (-4.05, -3.49)High-middle SDI50,545 (41,348, 58,939)2.86 (2.32 to 3.33)-5.02 (-5.29, -4.75)High SDI8668 (7820, 9364)0.52 (0.48 to 0.56)-0.78 (-1.77, 0.21) Andean Latin America241 (162, 333)0.4 (0.28 to 0.56)-7.11 (-7.79, -6.44) Australasia123 (101, 148)0.28 (0.23 to 0.33)-1.06 (-3.2, 1.09) Caribbean782 (423, 1369)1.73 (0.92 to 3.08)-1.58 (-2.04, -1.11) Central Asia4728 (3952, 5765)4.99 (4.20 to 6.04)-3.82 (-4.57, -3.07) Central Europe1012 (871, 1163)0.65 (0.56 to 0.75)-5.72 (-6.68, -4.76) Central Latin America6802 (5875, 7754)2.84 (2.45 to 3.23)2.1 (-0.38, 4.58) Central sub-Saharan Africa5067 (1465, 10,186)4.98 (1.38 to 10.05)-2.17 (-2.48, -1.86) East Asia183,639 (125,297, 217,608)10.17 (7.02 to 11.93)-4.18 (-4.41, -3.95) Eastern Europe5495 (4680, 6414)2.14 (1.83 to 2.5)-7.96 (-8.81, -7.11) Eastern sub-Saharan Africa15,382 (4016, 31,248)4.49 (1.09 to 10.97)-3.55 (-3.65, -3.45) High-income Asia Pacific2029 (1723, 2241)0.51 (0.45 to 0.56)-1.48 (-1.71, -1.26) High-income North America4107 (3772, 4440)0.71 (0.66 to 0.76)2.65 (0.02, 5.27) North Africa and Middle East16,079 (2321, 20,747)2.97 (0.44 to 3.79)2.74 (2.25, 3.24) Oceania190 (44, 428)1.51 (0.36 to 3.22)0.17 (-0.08, 0.43) South Asia6692 (4863, 8314)0.41 (0.3 to 0.51)-3.94 (-4.04, -3.84) Southeast Asia47,484 (11,297, 64,070)7.66 (1.88 to 10.42)-3.7 (-3.85, -3.56) Southern Latin America73 (62, 87)0.10 (0.09 to 0.13)-3.65 (-4.52, -2.78) Southern sub-Saharan Africa1510 (1279, 1824)2.01 (1.72 to 2.41)-1.63 (-1.95, -1.31) Tropical Latin America2410 (2181, 2656)1.19 (1.06 to 1.33)-6.9 (-7.35, -6.44) Western Europe1311 (1182, 1418)0.17 (0.15 to 0.18)-1.67 (-3.2, -0.15) Western sub-Saharan Africa2323 (695, 4595)0.41 (0.15 to 0.76)-2.06 (-2.27, -1.84)CI, confidence interval; DALY, disability-adjusted life-years; IQR, interquartile range; SDI, sociodemographic index; UI, uncertainty interval.a Percent change in rate refer to average annual percent changes between 1990 and 2019. Open table in a new tab CI, confidence interval; DALY, disability-adjusted life-years; IQR, interquartile range; SDI, sociodemographic index; UI, uncertainty interval. Notably, acute GN most often results from a soft tissue infection such as beta-hemolytic streptococci pharyngitis in children, namely acute post-streptococcal GN.7Balasubramanian R. Marks S.D. Post-infectious glomerulonephritis.Paediatr Int Child Health. 2017; 37: 240-247Crossref PubMed Scopus (15) Google Scholar Consistent with the previous studies, we found that the highest rate of prevalence and incidence occurred in children. As shown in Figure S2, the initial increased peak in the age-standardized prevalence and incidence was, respectively, in the 10 to 14 age group, followed by a decline in younger adults, and accompanied by a small wave with some fluctuations in the older population. Acute GN can also occur in adults. Most previous studies about acute GN were limited to children with acute post-streptococcal GN. Therefore, studies involving adults are needed. Different forms of acute GN occur in elderly people, especially those who are immunocompromised with health conditions such as diabetes. For example, protozoal and viral infections in the skin occur more frequently than streptococcal pharyngeal infections as a cause of acute GN in elderly patients.8Hamouda M. Mrabet I. Dhia N.B. et post-infectious glomerulonephritis in a J PubMed Scopus Google Scholar immunoglobulin A nephropathy and GN can result in acute M. Mrabet I. Dhia N.B. et post-infectious glomerulonephritis in a J PubMed Scopus Google GN is the underlying cause of acute GN in the elderly due to a of of the and Rapidly progressive GN can result in acute kidney injury requiring and a to and within the aging population. In this we found that the age-standardized rates of mortality and DALYs increased with and in the to age in 2019 These rates were in than in were of rates were to those of of prevalence, incidence, mortality, and DALYs in 2019 Thus, the elderly population on to the disease burden of acute GN in the In this was found between age-standardized incidence, age-standardized prevalence rates sociodemographic in 2019 and and However, a between and age-standardized mortality as as DALYs was results were also seen in expected age-standardized rates on in Notably, East Asia and Southeast Asia had a burden than expected to mortality and from 1990 to 2019 and countries and territories such as China, Laos, and North Korea had age-standardized mortality and DALYs than expected in 2019 and These results that the burden of acute GN be generally at of due to the of acute post-infectious The underlying be by the and to is more common in countries than in which had infections due to A. and prevalence of glomerulonephritis.Kidney Int Full Text Full Text PDF PubMed Scopus Google Scholar Thus, population about is to the burden of acute GN, particularly in the Asia In the prevalence, incidence, mortality, and to acute GN have decreased a disease burden in children and elderly people, particularly in some Asian about acute GN in is to the burden of acute GN. is by of China The had in data data of this The the and the who the and in and at of at for the of the and The 2019, by of and provides the and is not to the is a and not a requiring by the (2.29 with Table Classification of Diseases as to acute GN in this Table of in 2019. Table age-standardized rates of prevalence, incidence, mortality and disability-adjusted life years from acute glomerulonephritis in 2019, and trends from 1990 to 2019 in in the national Figure changes of prevalence, incidence, mortality, and disability-adjusted life years for in 2019. and annual percent changes of prevalence, incidence, mortality, and disability-adjusted life respectively. Figure point prevalence incidence mortality and disability-adjusted life years for acute glomerulonephritis per 100,000 population by and age in 2019. and and respectively. Figure S3. Global of prevalent incident mortality and DALYs by and age in 2019. Figure sociodemographic and age-standardized rates of prevalence incidence mortality and disability-adjusted life years in in 2019. Figure sociodemographic and age-standardized rates of prevalence incidence mortality and disability-adjusted life years in 195 countries in 2019. Figure The between and expected age-standardized prevalence from to 2019 in Figure The between and expected age-standardized incidence from to 2019 in Figure The between and expected age-standardized mortality from to 2019 in Figure The between and expected age-standardized disability-adjusted life years from to 2019 in Figure DALYs rate for acute glomerulonephritis per 100,000 population for 195 countries by sociodemographic in 2019. Figure mortality rate for acute glomerulonephritis per 100,000 population for 195 countries by sociodemographic in 2019. expected disease rates on sociodemographic in are for the age-standardized mortality rate in

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