Patterns of renal disease in South Africa

Abstract

The prevalence and patterns of renal disease in the different racial groups in South Africa is reviewed. South Africa is populated by four groups: Blacks, Whites, Indians and 'Coloured' or Mixed race. In 1994, the South African Dialysis and Transplant Registry (SADTR) recorded 3399 patients (99 pmp) on treatment for end-stage renal failure (ESRF). Glomerulonephritis (GN) was recorded as the cause of ESRF in 1771 (52.1%) patients and hypertension (HPT) in 1549 (45.6%) patients. In a study of 394 patients with ESRF in our unit, HPT was the cause of ESRF in 32% of Blacks and 24% of Indians, GN in 25% of Blacks and Indians and 33% of 'Coloured' patients, while analgesic nephropathy caused ESRF in 33% of White patients. A study of 3632 patients with ESRF reported HPT as the aetiology in 4.3% of Whites, 13.8% of Indians and 34.6% of Blacks, with 57% of the latter having malignant hypertension. Of adult Black patients with primary GN, 36% had mesangiocapillary GN, while 21% had membranous GN and 10.7% minimal change disease. Black children have a low prevalence of minimal change disease: 13.5% compared with 75% in Indians. IgA nephropathy is rare in Blacks and has been reported in two patients in another study. Hepatitis B infection occurred in 73% of Black children with membranous GN. Prevalence data for hepatitis C-associated GN is lacking, but antibody-positive figures of 4.8-21% have been reported in South African dialysis and transplant patients. Prevalence figures for HIV-associated renal disease are not available. Public health measures are being actively implemented and should modify the prevalence and pattern of renal disease in South Africa.