부산대학교 도서관

BACKGROUND: The incidence and prevalence of end-stage renal disease (ESRD) in Taiwan are 523/10^5 and 3,587/10^5 in 2018, which are still the top in the world. This study reviews the evolution of renal pathology and its association with socioeconomic parameters between 1982 and 2007. METHODS: Among the 5,266 renal biopsies collected, we excluded 786 graft biopsies, 527 re-biopsies, 145 inadequate specimens, and 19 specimens from ESRD patients. Thus, a total of 3,789 native renal biopsies were adequate for analysis from 1982 to 2007. This period was divided into three socioeconomic stages based on the gross domestic product (GDP) and public health policy: stage 1 (1982-1991; GDP was under 11,000 USD/yr), stage 2 (1992-1999; GDP was between 11,000 and 20,000 USD/yr), stage 3 (2000-2007; GDP was more than 20,000 USD/yr). RESULTS: The renal biopsies were divided into primary glomerulonephritis (GN) (n = 2,208, 58.3%), secondary GN (n = 1,330, 35.1%), and tubulointerstitial nephropathy (TIN) (n = 251, 6.6%). Among the renal diseases, primary GN showed the greatest progressive decrease over the 3 time periods, but secondary GN and TIN increased gradually. Immunoglobulin A nephropathy showed the greatest decrease in incidence (18.9%-15.3%), but minimal change disease increased (7.7%-10.5%). Lupus nephritis was the major secondary GN, but the incidence of diabetic nephropathy increased (2.5%-4.0%). Acute tubulointerstitial nephritis/acute tubular necrosis comprised the major proportion of TIN (64.1%) with a steady frequency over time, but chronic tubulointerstitial nephritis increased in the CKD period (3.5%). CONCLUSIONS: ESRD has reached epidemic proportions in Taiwan: both incidence and prevalence rates of the disease are the highest in the world. Our findings showed that rates of renal diseases changed in different socioeconomic stages over 25 years. This study provides an important contribution to our understanding of the epidemiology of renal diseases in Taiwan. A nationwide CKD Prevention Project that includes a multidisciplinary care program might help to prevent further exposure to nephrotoxic agents and allow for early diagnosis of renal disease by renal biopsy. Precise diagnosis of the etiology and optimal treatments are the solution to reduce the prevalence of ESRD.