Kidney Res Clin Pract > Volume 42(1); 2023 > Article
Qin, Zhao, Wei, Wang, Yu, Zhang, and Sun: Distribution of pathological types and epidemiological characteristics based on kidney biopsy in Northwest China



The spectrum of biopsy-confirmed kidney disease varies with regions and periods. We describe the distribution of pathological types and epidemiological characteristics of kidney diseases in Northwest China due to regional differences in geographical environment, social economy, and dietary habits.


Kidney biopsy cases from 2005 to 2020 in Xijing Hospital were retrospectively analyzed. Pathological characteristics of patients in different periods were analyzed using the t test or chi-square test. Joinpoint regression was used to analyze trends in pathological types and disease spectrum.


A total of 10,528 eligible patients were included. Primary glomerular disease (PGD) accounted for the majority of the cases and exhibited an obvious downward trend, whereas secondary glomerular disease (SGD) showed an obvious upward trend. Among PGD, immunoglobulin A nephropathy (IgAN) remained the most common pathological type, and the detection rate of membranous nephropathy (MN) was significantly increased. Among SGD, Henoch-Schönlein purpura nephritis (HSPN) was the most common pathological type and may present a significant characteristic of Northwest China. Diabetic nephropathy (DN) exhibited the most obvious upward trend in the whole process, whereas the fastest growth since 2012 was in hypertensive nephropathy.


The proportion of SGD increased whereas PGD declined. IgAN remained the most common PGD, and HSPN was the most common SGD. MN and DN showed the most obvious upward trend among PGD and SGD, respectively. Changes in the spectrum of kidney disease, especially the constituent ratio of SGD, pose a great challenge to public health.


In 2020, the Global Burden of Disease organization indicated that the global burden of kidney disease was increasing year by year [1]. At present, there are over 100 million people with chronic kidney disease (CKD) in China, and the percentage of hospitalized patients with the disease has increased from 3.58% (2010) to 4.95% (2017) [2]. To delay the progression to end-stage kidney disease (ESKD), the underlying etiology and pathology need to be clarified at the initial diagnosis.
The epidemiological study of nephropathy is helpful for early diagnosis and treatment in addition to understanding the epidemic trend of the disease. However, the differences in geographical environment, social economy, and dietary habits in different regions or countries contribute to the variation in the spectrum of kidney disease [3]. Intriguingly, the kidney disease spectrum varied in the same region even during a short period [4]. For example, in countries in East Asia, the detection rate of immunoglobulin A nephropathy (IgAN) and mesangial proliferative glomerulonephritis (MsPGN) can exceed 50% and the prevalence of IgAN and MsPGN has decreased in recent decades [5-7]. In China, the spectrum of kidney disease has changed due to the increasing incidence of hypertension, obesity, diabetes, and the increasing average age of the population [8]. In the United States, the frequency of diabetic kidney disease has increased dramatically over the past 30 years, whereas focal segmental glomerulosclerosis (FSGS) has declined over the past decade [9]. Therefore, it is of great significance to understand the updated epidemiological characteristics of kidney disease in a certain area and a fixed period to guide policy decisions on prevention in public health and therapeutic strategies in clinical practice [2].
Northwest China, located in the interior of China, is characterized by a vast area, drought and water shortages, extensive deserts, sandstorms, and a fragile ecology [10]. Due to the change in people’s economic conditions and lifestyles in recent years, we hypothesize that the population of Northwest China has a distinct spectrum of kidney diseases. However, contemporary large-scale epidemiological studies of kidney disease from Northwest China are lacking. Thus, we retrospectively analyzed a kidney biopsy cohort from the largest clinical center in Northwest China to explore the specific epidemiological characteristics of the kidney disease spectrum.


Study objective

Pathological and clinical data of 10,879 inpatients who underwent a kidney biopsy in Xijing Hospital (Air Force Military Medical University, Xi’an, China) from December 2005 to December 2020 were screened. Inclusion criteria were as follows: (1) patients who underwent a percutaneous kidney biopsy with ultrasound localization; (2) light microscopy, immunofluorescence, and electron microscopy were performed; (3) undiagnosed renal amyloidosis that required an abdominal fat pad biopsy and Congo red staining; and (4) in patients who had multiple biopsies, only the first result was included. Exclusion criteria were: (1) absence of original pathology report; (2) kidney transplant donors and patients; and (3) unsatisfactory biopsy specimens (the number of glomeruli in biopsy specimens was less than eight).

Data collection

Clinical and pathological data were collected by two researchers (Qin and Zhao). Pathological diagnosis was determined by consultation between the pathologist and clinician. Demographic data, diagnostic information, and laboratory data at the time of kidney biopsy were retrieved from electronic medical record information systems. This retrospective study was approved by the ethics committee of Xijing Hospital (No. KY20213027-1) and performed in accordance with the Declaration of Helsinki. Because of the retrospective design of the study, the need to obtain informed consent from eligible patients was waived by the ethics committee. We strictly protected the privacy of subject information during and after data collection.

Classification of clinicopathological diagnosis

According to the 1982 World Health Organization (WHO) histological classification of glomerular diseases [11] and the 1995 revision for glomerular diseases, renal histopathological diagnosis was classified as follows: (1) primary glomerular disease (PGD): IgAN, FSGS, MsPGN, membranoproliferative glomerulonephritis (MPGN), membranous nephropathy (MN), minimal change disease (MCD), crescentic glomerulonephritis (CreGN), endocapillary proliferative glomerulonephritis (EnPGN), IgM nephropathy (IgMN), sclerosing glomerulonephritis (SCGN), and unclassified; (2) secondary glomerular disease (SGD): Henoch-Schönlein purpura nephritis (HSPN), lupus nephritis (LN), diabetic nephropathy (DN), hypertensive nephropathy (HTN), hepatitis B associated nephropathy (HBVN), systemic vasculitis-associated renal damage (SVARD), proliferative glomerulonephritis with monoclonal immunoglobulin deposition (PGNMID), obesity-associated glomerulopathy (OAG), etc.; (3) hereditary nephropathy (HN): thin basement membrane nephropathy, Alport syndrome, Fabry disease etc.; (4) tubulointerstitial nephritis (TIN); and (5) other nephropathies were defined as unqualified morphological changes for WHO classification. Patients with two or more types of pathological diagnoses were reanalyzed by clinical nephrologists and pathologists in our center to determine the most important pathologic lesions.
The clinical diagnoses for kidney biopsy were categorized into six groups: (1) asymptomatic urinary abnormalities (AUA); (2) chronic nephritic syndrome (CNS); (3) nephrotic syndrome (NS); (4) acute kidney injury (AKI); (5) rapidly progressive glomerulonephritis (RPGN); and (6) others. These biopsy indicators have remained roughly the same over the past two decades. However, with the progression of technology, the relative contraindications of biopsy age and blood pressure requirements for elderly patients have been relaxed.

Statistical analysis

All patients enrolled were grouped according to a 5-year interval (period 1: 2005-2010, period 2: 2011-2015, and period 3: 2016-2020) and divided into five age groups for stratified analysis: ≤14, 15-30, 31-45, 46-60, and >60 years of age. The proportion of each pathological type in the total number was converted into a constituent ratio: (number of observed units of a certain component/total number of observed units of each component of the same object) × 100%. The Joinpoint Regression Program (JPR) statistical software version (Statistical Research and Applications Branch, National Cancer Institute, USA) established the time component ratio sequence data using multiple joinpoint models ( and was used for the regression analysis of the trend of the constituent ratio. The annual percentage change (APC) and average APC (AAPC) within the complete time interval of each rate were estimated using the optimal joinpoint model. IBM SPSS version 24.0 (IBM Corp., Armonk, NY, USA) was used for statistical analysis. Continuous variables were expressed as means ± standard deviation, and intergroup comparisons were performed by the chi-square test. A statistically significant difference was set at p < 0.05.


A total of 10,528 patients with clinicopathological data were included (Table 1). In summary, the proportions of various pathological subgroups were as follows: PGD (71.1%), SGD (26.1%), TIN (2.1%), HN (0.6%), and others (0.1%). The leading cause of PGD was IgAN (30.1%), followed by MN (20.1%), MsPGN (8.0%), FSGS (4.6%), MCD (3.7%), IgMN (1.6%), and SCGN (1.1%). The leading cause of SGD was HSPN (7.8%), followed by LN (6.4%), DN (3.8%), HTN (2.3%), HBVN (1.6%), renal amyloidosis (1.5%), and SVARD (1.2%) (Supplementary Table 1, available online).

Demographic characteristics

The geographical distribution of enrolled cases was mainly from Northwest China, including Shaanxi (60.2%), Gansu (18.5%), Shanxi (9.7%), Ningxia (4.4%), Qinghai (1.7%), and Xinjiang (0.3%), with a male/female ratio of 1.37:1. Their ages range from 6 to 88 years, and the average age was 38.73 ± 16.53 years. Regarding common pathologic types, the youngest participant had EnPGN (23.69 ± 18.49), whereas the oldest had renal amyloidosis (58.88 ± 9.01) (Table 2). During different periods, there was a significant increase in the average age (period 1: 34.34 ± 16.19, period 2: 37.75 ± 16.52, period 3: 41.93 ± 16.07; p < 0.001) (Table 3). Patients aged 46-60 years increased from 17.4% to 28.0%, and those aged >60 years increased from 7.9% to 14.7% (p < 0.001). IgAN and HSPN had age distribution peaks in the 15-30-year age group (41.1% and 39.2%), whereas MN had age distribution peaks in the 45-60-year age group (34.3%) (Fig. 1A). The largest proportion of male appears in the HTN group, whereas the largest proportion of female appears in the LN group (Fig. 1B).

Changes in the constituent ratio of the kidney biopsy disease spectrum

According to the constituent ratio analysis of all cases grouped by period (Fig. 1C), the proportion of SGD increased significantly from 23.2% (period 1) to 29.1% (period 3), whereas that of PGD decreased relatively from 74.2% (period 1) to 67.7% (period 3). In the multiple joinpoint models, a key joinpoint came in 2012 (Fig. 2). In summary, the proportions of PGD and SGD fluctuated steadily from 2005 to 2012, with APC values of 0.5% (95% confidence interval [CI], -1.1 to 2.1; p = 0.51) and -1.5% (95% CI, -5.8 to 3.1; p = 0.496), respectively. Nevertheless, from 2012 to 2020, the APC of PGD changed to -2.0% (95% CI, -3.2 to -0.7; p = 0.01), whereas that of SGD was 4.4% (95% CI, 0.6-8.3; p = 0.03) (Supplementary Table 2, 3, available online), indicating that the proportion of PGD showed an obvious downward trend after 2012, while SGD showed an obvious upward trend.

Trend analysis of the constituent ratio of the common type of primary glomerular disease

IgAN was the most common type of PGD during the study period, whereas the proportion showed a decreasing trend (Fig. 3) (APC, -0.9%; 95% CI, -2.9 to 1.1; p = 0.35) (Supplementary Table 4, 5, available online). A downward trend was also shown for MsPGN (APC, -14.2%; 95% CI, -17.8 to -10.4; p < 0.001) and FSGS (APC, -1.7%; 95% CI, -6.2 to 2.9; p = 0.43). MN and MCD presented an increasing trend, of which MN was divided into two segments (2005-2011: APC, 25.8%; 95% CI, 6.3-48.7; p = 0.01; 2011-2020: APC, 3.7%; 95% CI, -5.3 to 13.5; p = 0.40). Despite the growth rate of MN slowing down after 2011, MN had the most significant growth trend both in terms of constituent ratio and the number of patients, and MCD showed a continuous increase (2005-2020; APC, 20.0%; 95% CI, 15.3-25.0; p < 0.001).

Trend analysis of the constituent ratio of the common type of secondary glomerular disease

HSPN was the most common type of SGD with the highest proportion (29.9%). Nevertheless, the proportion of HSPN showed an obvious downward trend (Fig. 4) (2005-2020; APC, -8.8%; 95% CI, -10.6 to -7.0; p < 0.001) (Supplementary Table 6, 7, available online). LN also showed a significant downward trend (2005-2020; APC, -3.1%; 95% CI, -5.0 to -1.1; p < 0.001). Meanwhile, DN and HTN showed a huge growth trend over time, with APC achieving 20.0% (2005-2020; 95% CI, 16.4-23.7; p < 0.001) and 46.6% (2012-2020; 95% CI, 18.3-81.7; p = 0.002), respectively. Since 2018, DN has become the most common type of SGD. Another notable change in trend appeared for HBVN, with a clear joinpoint in 2013. From 2005 to 2013, there was a significant upward trend (APC, 13.5%; 95% CI, 2.2-26; p = 0.02), whereas a continuous declining trend manifested thereafter (APC, -29.9%; 95% CI, -38.4 to -20.4; p < 0.001).

The relationship between pathological diagnosis and clinical diagnosis

The indications for kidney biopsy mainly included AUA (14.1%), CNS (51.6%), NS (30.0%), AKI (3.9%), RPG (0.3%), and others (0.2%). MN (47.3%) was the dominant cause of NS, followed by MsPGN (10.1%) (Supplementary Table 8, available online). From the age-stratified comparative analysis of indications for kidney biopsy (Supplementary Table 9, available online), AUA had an obvious distribution peak in the 15-30-year age group (48.7%). On the other hand, most clinical manifestations of MCD (73.8%), MN (70.8%), and renal amyloidosis (67.7%) were NS. The major complications in our group were hypertension (29.9%), hyperlipidemia (37.6%), and renal anemia (10.1%). In addition to HTN, hypertension was the main complication of DN (80.1%), SCGN (68.3%), and MPGN (51.5%). Hyperlipidemia was the main complication of MN (76.2%), MCD (75.1%), and renal amyloidosis (69.0%). Renal anemia was the main complication of SVARD (52.0%), SCGN (40.8%), and DN (37.9%).


This report selected the largest kidney disease center in Northwest China for epidemiological statistical data from 10,528 kidney biopsy patients. The descriptive results of kidney biopsies indicated that kidney disease in Northwest China is more common among the young and middle-aged populations, and the age of onset is increasing. During the study period, the composition ratio of various pathological types changed significantly.
PGD was the most common kidney disease in this study, which is consistent with the data from other centers including East [12-14], Central [15], and South [16] China (ranging from 65.1% to 71.1%). It is also the main kidney disease in East Asia in countries such as South Korea and Japan [5,17]. Conversely, in Western countries such as the United States and the United Kingdom, there was a higher proportion of SGD [2,18]. Interestingly, we indicated an obvious upward trend in SGD, which may reflect the evolution of the renal disease spectrum from developing countries to developed countries under the context of rapid economic growth and urbanization. In the specific analysis of PGD, we identified that IgAN still accounted for the highest proportion. This is consistent with the report from East Asia in countries [17,19] such as Japan and South Korea, as well as some other international data (Spain, Czech Republic, Denmark, Italy, Scotland, Kuwait, and Turkey) [6,20-22]. FSGS showed the highest proportion in Europe [22] and MPGN showed the highest proportion in South Africa [15]. In addition to the findings in our research, a decreasing trend in IgAN was also observed in Northeast [12], South [16], and Central [15] China, which may be due to the sudden increase in MN morbidity and the gradual rise in SGD rates.
MN was the disease with the second greatest incidence in our study, and the majority of patients were middle-aged and elderly (>45 years, 57.0%). The rapid growth of MN not only appears in Northwest China, but also in other regions of the country [14,15,23], and has attracted the attention of researchers. In addition to ethnic or genetic factors, a lot of attention has been focused on environmental effects. Air pollution increases the circulating levels of inflammatory mediators, such as tumor necrosis factor-α, interleukin-6, and plasminogen activator inhibitor-1, and genetic polymorphisms in these cytokines are associated with the development of MN [24]. In a large kidney biopsy series in China [23] and India [25], researchers found that the increased frequency of MN was associated with long-term exposure to high levels of particulate matter less than 2.5 µm (PM2.5). In contrast, in developed countries with lower PM2.5 exposure levels, such as Japan [5], Korea [19], France [26], and the United States [9], the MN prevalence has remained stable or even reversed [24]. Regarding current trends, MN has already become the most common type of PGD in some parts of China with high PM2.5 levels [14,15,23]. Judging from the trend chart, coupled with the aggravation of air pollution, the frequent occurrence of haze, and the increase in PM2.5 pollution in Northwest China [27], the prevalence of MN may further increase. This is probably the most notable change in the spectrum of kidney disease in Northwest China.
In regards to the pathological types of SGD, HSPN ranked first in Northwest China and was significantly higher than in other regions of China [7,15,16]. The pathological data of kidney biopsies in Gansu Province also showed that the proportion of HSPN in SGD was the highest (26.1%) [28]. Therefore, it is reasonable to suggest that a high incidence of HSPN is a prominent feature in Northwest China. Intensive exposure to dust weather and other allergic factors in this area, which have a stronger pro-inflammatory effect and cause acute irritant effects on human health including some severe allergic reactions, may contribute to this epidemic character [28,29]. Although the number of HSPN cases remained at a high level, the composition ratio showed a downward trend. This may be related to the significant increase in other types of SGD. LN was the second most common form of SGD in our data and showed a downward trend. However, in Central, Eastern, and Southern China, LN remains the most common form of SGD [13,15,16]. The high incidence of LN is indeed a significant feature of SGD in China.
HTN had the highest growth rate in our study, which was in line with that of Japan and Korea [17]. China has approximately 270 million people with high blood pressure, making it the country with the largest absolute burden of hypertension in the world, and the prevalence rate is increasing year by year [30]. Currently, the proportion of HTN in patients with ESKD varies among different countries [31]. The incidence of HTN will undoubtedly increase in the future with the aging of the population and improvements in cardiovascular disease survival. However, the diagnosis of HTN at present is nonspecific and is mainly based on clinical manifestations [32]. Several studies that have compared biopsy-proven HTN with clinical HTN have found that the former could not be distinguished from renal damage caused by PGD, and the misdiagnosis rate was more than half [33,34]. To avoid misdiagnosis, the biopsy rate of HTN should be further improved. The diagnostic policy of DN is similar to that of HTN at present, and often only a kidney biopsy will make a differential diagnosis possible [35]. Although the detection rate of DN may be underestimated, we have found that it has become the most common type of SGD since 2018. According to the 2019 Scientific Report of Kidney Disease in China, DN has become the leading cause of CKD in hospitalized patients in China, as well as HTN [2]. In addition, in less-developed regions such as Northwest China, hypertension and diabetes are also highly prevalent and poorly managed due to low awareness, treatment, and control rates [36]. Therefore, there is much to be done in improving the diagnosis and management of hypertension and diabetes.
A change in the proportion of HBVN was also noted. The global prevalence of chronic hepatitis B is serious, particularly in certain developing countries, including China [37]. Western China has the highest incidence of hepatitis B in the country [38]. In a joinpoint analysis using hepatitis B morbidity and mortality data from the China Data Center for Public Health Sciences and demographic data from the National Bureau of Statistics, the reported incidence reached an inflection point in 2006 [37]. Our data reflects the epidemic profile of the disease from one side. The proportion of HBVN showed a peak in 2013, which may be attributed to the control of hepatitis B infection and the widespread use of the hepatitis B vaccine in China. As expected, the population affected by and constituent ratio of HBVN should decrease further.
In our study, CNS was the most common clinical indication for kidney biopsy, followed by NS. Due to inconsistencies in clinical indication and variation in renal biopsy policies in different regions, the conclusions also varied, such as in Japan (CNS, followed by NS), South Korea (AUA, followed by NS), Turkey (NS, followed by AUA), and Central China (NS, followed by CNS) [15,22]. However, NS is generally considered to be the most important indicator for biopsy, and MCD is the most common form of NS in children whereas MN is the most common form in adults [39]. In Japan, approximately 40% of patients with primary NS are diagnosed with MCD [5]. In contrast to the management of NS in adults, a diagnostic kidney biopsy is generally not performed upon presentation in children to establish a diagnosis [39]. Therefore, the proportion of MCD in patients with NS may be underestimated.
The high incidence of hypertension in our study reflected a significant impact on prognosis. The Kidney Disease: Improving Global Outcomes (KDIGO) 2021 Clinical Practice Guideline for the Management of Blood Pressure in CKD reemphasizes the importance of blood pressure management [40]. Renal anemia is a common clinical manifestation of CKD, which increases the risk of ESKD, cardiovascular events, and death [41]. In addition to vascular inflammatory nephropathies such as SVARD and SCGN, DN is most associated with renal anemia. Anemia in DN not only occurs early and seriously but also promotes the progression of DN and induces and aggravates diabetic complications.
This study provides information about the latest epidemic spectrum of kidney disease in Northwest China, which is expected to provide a basis for public health prevention and therapeutic strategy. Generally, kidney disease is more common among the young and middle-aged populations, and the age of onset is increasing. PGD accounted for most cases of kidney disease in this group. The proportion of SGD increased while PGD declined. IgAN remained the most common pathological type, while MN significantly increased. HSPN was the most common pathological type of SGD and could be a hallmark of Northwest China. DN showed the most obvious increasing trend in types of SGD from the analysis, whereas the fastest growth since 2012 was in HTN. Moreover, HBVN showed a joinpoint from increase to decrease. The spectrum changes of kidney disease, especially the constituent ratio of SGD, pose a great challenge to public health.


Conflicts of interest

All authors have no conflicts of interest to declare.


The Xijing Hospital discipline promoting plan (Reference number: XJZT21L15), National Natural Science Foundation of China grants (Reference number: 81670655), and Key projects of Shaanxi province (Reference number: 2017ZDXM-SF-045) supported this study.

Data sharing statement

The data presented in this study are available on request from the corresponding author.

Authors’ contributions

Conceptualization: SS

Data curation: YQ, JZ, ZY

Formal analysis: YQ, YW, ZY, YZ

Funding acquisition: SS

Methodology: XW

Project administration: SS

Software: YQ, XW

Writing-original draft: YQ

Writing-review & editing: SS, JZ, ZY, YZ

All authors read and approved the final manuscript.


The authors would like to acknowledge all statisticians for participating in this study.

Figure 1.

The distribution of kidney biopsy based on different age groups and genders.

(A) The age distribution according to pathological findings. (B) The gender distribution according to pathological findings. (C) Changes in the constituent ratio of kidney biopsy disease spectrum in different periods.
CreGN, crescentic glomerulonephritis; DN, diabetic nephropathy; EnPGN, endocapillary proliferative glomerulonephritis; FSGS, focal segmental glomerulosclerosis; HBVN, hepatitis B associated nephropathy; HN, hereditary nephropathy; HSPN, Henoch-Schönlein purpura nephritis; HTN, hypertensive nephropathy; IgAN, immunoglobulin A nephropathy; IgMN, immunoglobulin M nephropathy; LN, systemic lupus erythematosus nephritis; MCD, minimal change disease; MN, membranous nephropathy; MPGN, membranoproliferative glomerulonephritis; MsPGN, mesangial proliferative glomerulonephritis; OAG, obesity-associated glomerulopathy; PGD, primary glomerular disease; SCGN, sclerosing glomerulonephritis; SGD, secondary glomerular disease; SVARD, systemic vasculitis-associated renal damage; TIN, tubulointerstitial nephritis.
**p < 0.01.
Figure 2.

Changes in the constituent ratio of kidney biopsy disease spectrum.

APC, annual percentage change; PGD, primary glomerular disease; SGD, secondary glomerular disease.
aAPC is significantly different from zero at the alpha = 0.05 level.
Figure 3.

Trend analysis of the constituent ratio of common primary glomerular disease.

APC, annual percentage change; FSGS, focal segmental glomerulosclerosis; IgAN, immunoglobulin A nephropathy; MN, membranous nephropathy; MsPGN, mesangial proliferative glomerulonephritis; MCD, minimal change disease.
aAPC is significantly different from zero at the alpha = 0.05 level.
Figure 4.

Trend analysis of the constituent ratio of common secondary glomerular disease.

APC, annual percentage change; DN, diabetic nephropathy; HBVN, hepatitis B associated nephropathy; HSPN, Henoch-Schönlein purpura nephritis; HTN, hypertensive nephropathy; LN, systemic lupus erythematosus nephritis.
aAPC is significantly different from zero at the alpha = 0.05 level.
Table 1.
Baseline characteristics of kidney biopsy patients (n = 10,528)
Characteristic Value
Male sex 6,004 (57.0)
Age (yr) 38.73 ± 16.53
No. of glomeruli 22.19 ± 10.34
Asymptomatic urinary abnormalities 1,486 (14.1)
Chronic nephritic syndrome 5,429 (51.6)
Nephrotic syndrome 3,157 (30.0)
Acute kidney injury 405 (3.8)
Rapidly progressive glomerulonephritis 29 (0.3)
Isolated microscopic hematuria 879 (8.3)
Renal insufficiencya 1,850 (17.6)
Hypertension 3,147 (29.9)
Hyperlipidemia 3,963 (37.6)
Renal anemia 1,066 (10.1)

All data are presented as values at the time of kidney biopsy. Data are expressed as number (%) and mean ± standard deviation.

a Estimated glomerular filtration rate, <60 mL/min/1.73 m2.

Table 2.
Comparative analysis of common pathological types and age stratification
Pathological diagnosis Age (yr) Total (n = 10,528) Age group (yr)
≤14 15-30 31-45 45-60 >60
IgAN 34.53 ± 13.63 3,165 (30.1) 129 (4.1) 1,301 (41.1) 1,078 (34.1) 504 (15.9) 153 (4.8)
MN 46.16 ± 16.11 2,111 (20.1) 17 (0.8) 399 (18.9) 491 (23.3) 725 (34.3) 479 (22.7)
MsPGN 36.34 ± 15.53 838 (8.0) 48 (5.7) 267 (31.9) 260 (31.0) 190 (22.7) 73 (8.7)
FSGS 28.49 ± 14.96 486 (4.6) 18 (3.7) 126 (25.9) 181 (37.3) 117 (24.1) 44 (9.1)
MCD 35.14 ± 17.84 386 (3.7) 35 (9.1) 147 (38.1) 87 (22.5) 67 (17.4) 50 (13.0)
IgMN 31.39 ± 14.03 168 (1.6) 14 (8.3) 71 (42.3) 46 (27.4) 31 (18.5) 6 (3.6)
SCGN 38.92 ± 15.34 120 (1.1) 6 (5.0) 30 (25.0) 44 (36.7) 27 (22.5) 13 (10.8)
CreGN 45.41 ± 16.69 76 (0.7) 0 (0) 17 (22.4) 18 (23.7) 21 (27.6) 20 (26.3)
EnPGN 23.69 ± 18.49 70 (0.7) 37 (52.9) 13 (18.6) 8 (11.4) 5 (7.1) 7 (10.0)
MPGN 49.56 ± 15.89 66 (0.6) 2 (3.0) 10 (15.2) 9 (13.6) 25 (37.9) 20 (30.3)
HSPN 24.91 ± 15.15 819 (7.8) 215 (26.3) 371 (45.3) 130 (15.9) 62 (7.6) 41 (5.0)
LN 35.14 ± 13.65 675 (6.4) 23 (3.4) 243 (36.0) 231 (34.2) 146 (21.6) 32 (4.7)
DN 54.03 ± 9.78 401 (3.8) 0 (0) 7 (1.8) 51 (12.7) 214 (53.4) 129 (32.2)
HTN 45.34 ± 13.15 238 (2.3) 0 (0) 28 (11.8) 93 (39.1) 75 (31.5) 42 (17.7)
HBVN 42.31 ± 13.65 165 (1.6) 2 (1.2) 31 (18.8) 59 (35.8) 56 (33.9) 17 (10.3)
Renal amyloidosis 58.88 ± 9.01 158 (1.5) 0 (0) 0 (0) 9 (5.7) 73 (46.6) 76 (48.1)
SVARD 58.45 ± 13.38 123 (1.2) 0 (0) 5 (4.1) 14 (11.4) 32 (26.0) 72 (58.5)
TIN 45.96 ± 14.85 216 (2.1) 2 (0.9) 35 (16.2) 59 (27.3) 73 (33.8) 47 (21.8)

Data are expressed as number (%) and mean ± standard deviation.

CreGN, crescentic glomerulonephritis; DN, diabetic nephropathy; EnPGN, endocapillary proliferative glomerulonephritis; FSGS, focal segmental glomerulosclerosis; HBVN, hepatitis B associated nephropathy; HSPN, Henoch-Schönlein purpura nephritis; HTN, hypertensive nephropathy; IgAN, immunoglobulin A nephropathy; IgMN, immunoglobulin M nephropathy; LN, systemic lupus erythematosus nephritis; MCD, minimal change disease; MN, membranous nephropathy; MPGN, membranoproliferative glomerulonephritis; MsPGN, mesangial proliferative glomerulonephritis; SCGN, sclerosing glomerulonephritis; SVARD, systemic vasculitis-associated renal damage; TIN, tubulointerstitial nephritis.

Table 3.
Characteristics of age distribution in different periods
Period Total Average age (yr) Age group (yr)
≤14 15-30 31-45 46-60 >60
1 2,258 (21.5) 34.34 ± 16.19 190 (8.4) 852 (37.7) 645 (28.6) 392 (17.4) 179 (7.9)
2 3,926 (37.3) 37.75 ± 16.52 245 (6.2) 1,314 (33.5) 1,072 (27.3) 877 (22.3) 418 (10.8)
3 4,344 (41.3) 41.93 ± 16.07 128 (3.0) 1,120 (25.8) 1,240 (28.6) 1,217 (28.0) 639 (14.7)
Total 10,528 38.73 ± 16.53 563 (5.4) 3,286 (31.2) 2,957 (28.1) 2,486 (23.6) 1,236 (11.7)

Data are expressed as number (%) and mean ± standard deviation.


1. GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2020;395:709-733.
pmid pmc
2. Yang C, Wang H, Zhao X, et al. CKD in China: evolving spectrum and public health implications. Am J Kidney Dis 2020;76:258-264.
crossref pmid
3. Zhang L, Long J, Jiang W, et al. Trends in chronic kidney disease in China. N Engl J Med 2016;375:905-906.
crossref pmid
4. Huang YM, Xu D, Long J, et al. Spectrum of chronic kidney disease in China: a national study based on hospitalized patients from 2010 to 2015. Nephrology (Carlton) 2019;24:725-736.
crossref pmid pdf
5. Sugiyama H, Yokoyama H, Sato H, et al. Japan Renal Biopsy Registry: the first nationwide, web-based, and prospective registry system of renal biopsies in Japan. Clin Exp Nephrol 2011;15:493-503.
crossref pmid pdf
6. Shin HS, Cho DH, Kang SK, et al. Patterns of renal disease in South Korea: a 20-year review of a single-center renal biopsy database. Ren Fail 2017;39:540-546.
crossref pmid pmc pdf
7. Yang Y, Zhang Z, Zhuo L, Chen DP, Li WG. The spectrum of biopsy-proven glomerular disease in China: a systematic review. Chin Med J (Engl) 2018;131:731-735.
pmid pmc
8. Yang C, Gao B, Zhao X, et al. Executive summary for China Kidney Disease Network (CK-NET) 2016 Annual Data Report. Kidney Int 2020;98:1419-1423.
crossref pmid
9. O’Shaughnessy MM, Hogan SL, Poulton CJ, et al. Temporal and demographic trends in glomerular disease epidemiology in the Southeastern United States, 1986-2015. Clin J Am Soc Nephrol 2017;12:614-623.
crossref pmid pmc
10. Yang X, Chen R, Ji G, Wang C, Yang Y, Xu J. Assessment of future water yield and water purification services in data scarce region of Northwest China. Int J Environ Res Public Health 2021;18:8960.
crossref pmid pmc
11. Katz SM. Renal disease: classification and atlas of glomerular diseases. JAMA 1982;248:2053-2054.
12. Chen L, Luodelete M, Dong C, et al. Pathological spectrum of glomerular disease in patients with renal insufficiency: a single-center study in Northeastern China. Ren Fail 2019;41:473-480.
crossref pmid pmc pdf
13. Nie P, Chen R, Luo M, et al. Clinical and pathological analysis of 4910 patients who received renal biopsies at a single center in Northeast China. Biomed Res Int 2019;2019:6869179.
crossref pmid pmc pdf
14. Tang L, Yao J, Kong X, et al. Increasing prevalence of membranous nephropathy in patients with primary glomerular diseases: a cross-sectional study in China. Nephrology (Carlton) 2017;22:168-173.
crossref pmid pdf
15. Hu R, Quan S, Wang Y, et al. Spectrum of biopsy proven renal diseases in Central China: a 10-year retrospective study based on 34,630 cases. Sci Rep 2020;10:10994.
crossref pmid pmc pdf
16. Hou JH, Zhu HX, Zhou ML, et al. Changes in the spectrum of kidney diseases: an analysis of 40,759 biopsy-proven cases from 2003 to 2014 in China. Kidney Dis (Basel) 2018;4:10-19.
crossref pmid pmc pdf
17. Kim K, Lee SH, Lee SW, Lee JP, Chin HJ; Korean GlomeruloNEphritis sTudy (KoGNET) Group. Current findings of kidney biopsy including nephropathy associated with hypertension and diabetes mellitus in Korea. Korean J Intern Med 2020;35:1173-1187.
crossref pmid pmc pdf
18. Liu ZH. Nephrology in China. Nat Rev Nephrol 2013;9:523-528.
crossref pmid pdf
19. Yim T, Kim SU, Park S, et al. Patterns in renal diseases diagnosed by kidney biopsy: a single-center experience. Kidney Res Clin Pract 2020;39:60-69.
crossref pmid pmc
20. AlYousef A, AlSahow A, AlHelal B, et al. Glomerulonephritis histopathological pattern change. BMC Nephrol 2020;21:186.
crossref pmid pmc pdf
21. Gesualdo L, Di Palma AM, Morrone LF, et al. The Italian experience of the national registry of renal biopsies. Kidney Int 2004;66:890-894.
crossref pmid
22. Turkmen A, Sumnu A, Cebeci E, et al. Epidemiological features of primary glomerular disease in Turkey: a multicenter study by the Turkish Society of Nephrology Glomerular Diseases Working Group. BMC Nephrol 2020;21:481.
crossref pmid pmc pdf
23. Xu X, Wang G, Chen N, et al. Long-term exposure to air pollution and increased risk of membranous nephropathy in China. J Am Soc Nephrol 2016;27:3739-3746.
crossref pmid pmc
24. Zhang XD, Cui Z, Zhao MH. The genetic and environmental factors of primary membranous nephropathy: an overview from China. Kidney Dis (Basel) 2018;4:65-73.
crossref pmid pmc pdf
25. Narasimhan B, Chacko B, John GT, Korula A, Kirubakaran MG, Jacob CK. Characterization of kidney lesions in Indian adults: towards a renal biopsy registry. J Nephrol 2006;19:205-210.
26. Simon P, Ramee MP, Boulahrouz R, et al. Epidemiologic data of primary glomerular diseases in western France. Kidney Int 2004;66:905-908.
crossref pmid
27. Yang QQ, Tao H, Zhang Q, Wu LB, Wang XJ. An empirical analysis of the relationship between economic growth and haze pollution: a case study of Northwest China. Technol Econ Mark 2018;(2):104-105. In Chinese.
28. Wang Y, Wang W, Deng R, Shu H, Liang Y, Wang J. Clinical epidemiology of renal disease in Gansu province base on 1828 renal biopsy data. Chin J Nephrol 2019;35:212-214.
29. Dan L, Zhao YJ, Wang YX, Zhang HF, Gao HM, Zhou H. The pro-inflammatory effect and allergic reaction of airborne fine particles from smog and dust weather on human keratinocyte. J Toxicol 2017 31:102-108. In Chinese.
30. Wang ZW, Hu SS. Interpretation of report on cardiovascular health and diseases in China 2019. Chin J Cardiovasc Med 2020 25:401-410. In Chinese.
31. Kramer A, Boenink R, Noordzij M, et al. The ERA-EDTA Registry Annual Report 2017: a summary. Clin Kidney J 2020;13:693-709.
crossref pmid pmc pdf
32. Seccia TM, Caroccia B, Calò LA. Hypertensive nephropathy: moving from classic to emerging pathogenetic mechanisms. J Hypertens 2017;35:205-212.
crossref pmid
33. Mennuni S, Rubattu S, Pierelli G, Tocci G, Fofi C, Volpe M. Hypertension and kidneys: unraveling complex molecular mechanisms underlying hypertensive renal damage. J Hum Hypertens 2014;28:74-79.
crossref pmid pdf
34. Zucchelli P, Zuccalà A. Can we accurately diagnose nephrosclerosis? Nephrol Dial Transplant 1995;10 Suppl 6:2-5.
crossref pmid
35. Santoro D, Torreggiani M, Pellicanò V, et al. Kidney biopsy in type 2 diabetic patients: critical reflections on present indications and diagnostic alternatives. Int J Mol Sci 2021;22:5425.
crossref pmid pmc
36. Lin M, Heizhati M, Wang L, et al. Prevalence and associated factors of kidney dysfunction in patients with hypertension and/or diabetes mellitus from a primary care population in Northwest China. Int J Gen Med 2021;14:7567-7578.
crossref pmid pmc pdf
37. Liu ZX, Wang YS, Wang WB. Study on changes in hepatitis B incidence in China, 1990-2017. Zhonghua Liu Xing Bing Xue Za Zhi 2021;42:613-619.
38. Li T, Wang R, Zhao Y, Su S, Zeng H. Public awareness and influencing factors regarding hepatitis B and hepatitis C in Chongqing municipality and Chengdu City, China: a cross-sectional study with community residents. BMJ Open 2021;11:e045630.
crossref pmid pmc
39. Rovin BH, Adler SG, Barratt J, et al. Executive summary of the KDIGO 2021 guideline for the management of glomerular diseases. Kidney Int 2021;100:753-779.
crossref pmid
40. Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group. KDIGO 2021 clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int 2021;99(3S):S1-S87.
crossref pmid
41. Zhang S, Guo J, Xie S, Chen J, Yu S, Yu Y. Efficacy and safety of hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI) on anemia in non-dialysis-dependent chronic kidney disease (NDD-CKD): a systematic review and meta-analysis. Int Urol Nephrol 2021;53:1139-1147.
crossref pmid pdf

Editorial Office
#301, (Miseung Bldg.) 23, Apgujenog-ro 30-gil, Gangnam-gu, Seoul 06022, Korea
Tel: +82-2-3486-8736    Fax: +82-2-3486-8737    E-mail:                

Copyright © 2023 by The Korean Society of Nephrology.

Developed in M2PI

Close layer