Abstract
PURPOSE: This systematic review aims to synthesize data from biopsy-based studies to quantify the epidemiology, regional variations, and temporal trends of glomerular diseases (GDs) in Saudi Arabia. METHODS: We conducted a systematic search using PubMed, MEDLINE, the Cochrane Library, and Google Scholar to identify relevant studies published up to January 1, 2025. Studies reporting native renal-biopsy data from Saudi Arabia, with histopathological confirmation of GD, were included. Data extraction followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and study quality was assessed using the Newcastle-Ottawa Scale. RESULTS: Twelve studies (4066 patients) were included, representing all major regions of Saudi Arabia between 1989 and 2017. Primary GD accounted for 50%-80% of all biopsies, while secondary GD represented 18%-48%. Focal segmental glomerulosclerosis (FSGS) was the most common primary GD (15%-40% of cases), while lupus nephritis dominated secondary GD (55%-75%). Nephrotic syndrome was the principal indication for biopsy in all adult cohorts (40%-65%), particularly with minimal change disease (MCD), FSGS, and membranous glomerulonephritis (MGN) subtypes. Temporal trends revealed an increase in IgA nephropathy and diabetic nephropathy, with a decline in membranoproliferative glomerulonephritis. Notable regional variations were also identified. Progression to ESRD was observed in 25%-35% of crescentic and FSGS cases. CONCLUSION: This review highlights the evolving landscape of GDs in Saudi Arabia, emphasizing the need for early diagnosis, standardized biopsy protocols, and multidisciplinary management. A national renal biopsy registry is recommended to improve surveillance and research collaboration.