THE RACIAL PREVALENCE OF GLOMERULAR-LESIONS IN NEPHROTIC ADULTS

We retrospectively evaluated the prevalence of primary glomerular lesi ons in adults who had a renal biopsy for nephrotic proteinuria. From J uly 1975 to May 1994, 340 patients undergoing renal biopsies evaluated at Rush-Presbyterian-St Lukes Medical Center had the primary glomerul ar lesions of minimal-change disease, focal segmental glomerular scler osis (FSGS), membranous glomerulonephritis (MGN), membranoproliferativ e glomerulonephropathy, immunoglobulin A nephropathy, and immunotactoi d glomenrulopathy. The patients had a mean age of 43 +/- 17 years, 57% were male, and 50% were white, 36% were black, 7% were of other race, and 7% were of unknown race, The distribution of lesions for black pa tients was minimal-change disease 14%, FSGS 57%, MGN 24%, membranoprol iferative glomerulonephritis 2%, immunoglobulin A 2%, and immunotactoi d glomerulopathy 1%; for white patients, the distribution of lesions w as minimal-change disease 20%, FSGS 23%, MGN 36%, membranoproliferativ e glomerulonephropathy 6%, immunoglobulin A 8%, and immunotactoid glom erulopathy 6%, The prevalence of FSGS was significantly greater (P < 0 .0001) and that for MON, immunoglobulin A, and immunotactoid glomerulo pathy was significantly less (P < 0.05) for black patients compared wi th white patients, In a logistic regression analysis, race remained th e only significant predictor of FSGS (P = 0.0001), with black patients four times as likely to have FSGS as white patients, The distribution of lesions among white patients was similar based on gender, age, and biopsy period. For black patients the distribution was also similar b ased on gender and age, but over 20 years the incidence of FSGS increa sed from 39% (1975 to 1984) to 64% (1985 to 1994) (P < 0.01). Thus, si gnificant racial differences in the distribution of primary glomerular lesions exists, This has important prognostic and therapeutic implica tions for nephrotic adults. (C) 1996 by the National Kidney Foundation , Inc.