Histopathology findings in kidney biopsies at a tertiary hospital in Nairobi, Kenya

Kidney disease is a leading cause of morbidity and mortality globally. Glomerulonephritis is a leading cause of kidney disease that is best characterized by biopsy. There are limited data available on glomerulonephritis in the Kenyan population. Factors such as the prevalence of APOL1 high risk alleles, endemic HIV infection, high prevalence of other infectious diseases and increased susceptibility to autoimmune diseases may influence the prevalence of kidney disease in sub–Saharan Africa. This study aimed to describe selected clinical and histopathological findings in patients with medical kidney disease who had biopsies examined at the Aga Khan University Hospital, Nairobi. A retrospective chart review was done of the laboratory reports and clinical records of patients who had native medical kidney biopsies reported at Aga Khan University Hospital Nairobi from 2018 to 2024. Three hundred and forty-seven cases were reviewed. The commonest indication for renal biopsy was nephrotic syndrome (33.4%), followed by lupus nephritis/investigation for lupus nephritis (16.7%), abnormal urinalysis findings (8.3%) and acute kidney injury (8.0%). The mean serum creatinine was 225 mmol/l. The mean albumin creatinine ratio was 255 mg/mmol. The most frequent diagnosis in both adults and pediatric patients was focal segmental glomerulosclerosis (21.6%). The second most common diagnosis was lupus nephritis (14.6%) followed by advanced chronic changes (9.5%). The quality of biopsies reviewed was high, showing that both the technical expertise, equipment and facilities are available to perform biopsies but need scaling to adequately cover the entire population. Overall, the biopsy findings of our study reflect the epidemiology of biopsy findings as described in similar populations.