Pathological Basis of End-Stage Renal Disease and Renal Biopsy Diagnostic Characterisation in Patients Attending Nephrology Units Across South South Nigeria

The pathological characterisation of end-stage renal disease in Nigeria remains limited by low biopsy rates, inadequate histopathology infrastructure, and poor correlation between clinical diagnoses and histological findings, creating significant gaps in understanding the dominant nephropathy spectrum. This research provides a comprehensive pathological basis for ESRD and systematic renal biopsy characterisation in patients attending nephrology units at three tertiary hospitals in Rivers, Delta, and Cross River States, South South Nigeria. A prospective multi-centre cohort study will recruit 200 patients undergoing renal biopsy over three years. Native kidney biopsies will be processed for light microscopy, immunofluorescence, and transmission electron microscopy by standardised protocols. Histological diagnoses will be classified by the Oxford, ISN/RPS, and WHO classification systems. Clinical, serological, and genetic correlates will be systematically collected. Biomarker profiling including serum galactose-deficient IgA1, anti-PLA2R antibody, and ANCA will augment pathological characterisation. In a sub-study of 60 ESRD patients on haemodialysis, urinary biomarker trajectories before and after initiation of renal replacement therapy will be longitudinally characterised. Original contributions include the first systematic renal biopsy database for South South Nigeria, a characterisation of the dominant nephropathy spectrum in this region including malaria nephropathy, HIV nephropathy, and sickle cell nephropathy, and a theoretical framework linking environmental and infectious exposures to glomerular pathology patterns specific to the Niger Delta ecosystem. Keywords: renal biopsy, end-stage renal disease, glomerulonephritis, histopathology, South South Nigeria