Biopsy-proven glomerular diseases: a systematic review of global kidney biopsy registries

BACKGROUND: Glomerular diseases are a major contributor to chronic kidney disease (CKD) and kidney failure worldwide. The prevalence and spectrum of these diseases vary substantially across geographic regions, reflecting differences in genetic predisposition, environmental exposures, and healthcare practices. Although numerous kidney biopsy registries have been established globally, synthesizing their findings is required. The present systematic review aimed to integrate data from national and regional kidney biopsy registries to evaluate the global distribution of biopsy-proven glomerular diseases. METHODS: A comprehensive search was performed using MEDLINE, Embase, Scopus, Cochrane Library, and Google Scholar databases. Studies were eligible if they reported original data from kidney biopsy registries in adult patients undergoing native kidney biopsy, with histopathological diagnoses of primary or secondary glomerulonephritis. RESULTS: Thirty-nine studies met the inclusion criteria. IgA nephropathy was the most common primary glomerular disease worldwide, with exceptionally high prevalence in East Asia (up to 35.8%) and moderate prevalence in Europe (up to 20%). Membranous nephropathy and focal segmental glomerulosclerosis showed marked regional variability, with focal segmental glomerulosclerosis predominating in North and South America (over 20%). Among secondary glomerular diseases, lupus nephritis was more prevalent in South America, diabetic nephropathy in North America, and vasculitis-related glomerulonephritis in Europe and North America, with lower rates in Asia. CONCLUSIONS: Our findings support the critical role of biopsy registries in nephrology research and emphasize the need for international harmonization of biopsy protocols and diagnostic standards. Integrating histological, clinical, and molecular data constitutes a key step to advancing precision nephrology globally.