Unveiling glomerulonephritis in the Pacific: a Fijian cohort study

The epidemiology of kidney diseases is poorly known in several settings, including the Pacific Islands. To contribute to filling this gap, the current study aims to explore the incidence, distribution and patterns of biopsy-proven glomerulonephritis (GN) in Fiji, and describe the experience of organizing a kidney biopsy service in our resource-limited setting. All native kidney biopsies conducted in Fiji's public sector from 2019 to 2023 were included in the annual crude biopsy and complication rate. Biopsies that did not lead to diagnosis, that diagnosed a non-glomerular pathology, and repeat biopsies were excluded from evaluation which focused on GN. One hundred forty-two native kidney biopsies yielded an annual average crude biopsy rate of 31.6 per million population. Of them, 121 yielded a diagnosis of glomerulonephritis. Median age of the patients was 33.5 years (range 10-76), 66.1% were females, median estimated glomerular filtration rate (eGFR) was 44 mL/min/1.73m2 (Interquartile range [IQR] 21-88) and proteinuria 3.0 g/day (IQR 1.1-4.6). Most biopsies (88.4%) were evaluated by light microscopy alone. Nephrotic syndrome was the leading indication (38.8%), followed by undefined kidney impairment (24.8%), nephritic syndrome (19%), and isolated urinary abnormalities (17.4%). Lupus nephritis (43%), diabetic nephropathy (19%), and focal segmental glomerulosclerosis (8.3%) were the most common findings. In 16.5% of cases we were not able to identify a specific GN. Significant complications occurred in seven patients. In conclusion, a kidney biopsy service is central for allowing the diagnosis of GN in resource-limited settings, like Fiji. While our experience proves feasibility, efforts are needed to improve diagnostic yield and expand experience.