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Abstract: TH-PO475

Challenges in Diagnosis and Management of Glomerular Disease in a Resource-Limited Setting

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials


  • Ramachandran, Raja, Postgraduate Institute of Medical Education and Research, Chandigarh, India
  • Ulasi, Ifeoma I., College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
  • Onu, Ugochi Chika, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
  • Jha, Vivekanand, George Institute for Global Health, UNSW, Delhi, Delhi, India

Glomerular diseases are the leading driver of non-diabetic chronic kidney disease (CKD) disability-adjusted life years in third world countries. Proper diagnosis and treatment rely on access to resources, including kidney biopsy, ancillary testing and access to evidence-based therapies.


After an initial pilot phase, we conducted a cross-sectional internet-based survey among nephrologists in countries of Asia, Africa and Eastern Europe, Asia, Africa and Eastern Europe. In the survey, we collected the baseline demographic data, the ability to perform and appropriately interpret a kidney biopsy, and access to complementary investigations and treatment practices.


298 kidney care specialists took part in the survey (64% from academic/university hospitals). Eighty-two percent performed kidney biopsy. About 61% of the respondents could not get a kidney biopsy in >50% of patients with suspected glomerular disease. About 43% of the respondents from Africa had access only to light microscopy. Overall, the inability to undertake and fully evaluate a biopsy and perform ancillary investigations was more profound in Africa than in Asia. Sixty per cent of the participants reported >75% of their patients meeting the cost of diagnosis and treatment by out-of-pocket expenses. Empirical use of immunosuppression was higher in Africa than in Asia. The main barriers to diagnosis and treatment included a delayed presentation, incomplete diagnostic work-up and high cost of treatment.


There are major barriers to implementing a guideline-driven approach to the diagnosis and treatment of patients with glomerular disease in limited-resource countries.