Abstract
Background: Nephrotic syndrome is an important chronic disorder in children with clinical manifestation of different histopathological subtypes. An aim of the study was to determine incidence of renal biopsy in paediatric nephrotic syndrome, correlations between the clinical and histomorphological patterns in Indian ethnicity children at our tertiary care institute. Methods: : A retrospective study of kidney biopsies with, immunofluorescence and electron microscopy with clinical outcome of the children with nephrotic syndrome was done over a period of 15 years. Biopsies were stained with Hematoxylin & eosin, Periodic acid Schiff and silver impregnation stain and also processed for immunofluorescence and electron microscopy as necessary. All renal biopsy findings were correlated with clinical response to steroid therapy, immunosuppressant, and clinical parameters. Result: Frequencies in results were calculated by Chi square test for categorical variables. Mann-Whitney U test was used for non parametric variables. Predominantly cases were seen in the age group 8-12 years. Atypical nephrotic syndrome was the commonest presenting feature followed by steroid resistant nephrotic syndrome. Minimal change disease was the commonest histomorphological pattern followed by focal segmental glomerular sclerosis. All the cases of membranous glomerulonephritis in study were secondary in nature. Light microscopy findings correlated with electron microscopy, in 80.95% cases. Conclusion: Minimal change disease occurs up to 6 times more commonly in Indian children than in Europian counterpart, but rise in FSGS cases as a cause for nephrotic syndrome is now being encountered. In India the proportion of cases with Membrano-proliferative glomerulonephritis is high, attributable to the high prevalence of infectious diseases like tuberculosis, chronic suppurative infections and malnutrition. DOI: 10.21276/apalm.2017.995
Highlights
Nephrotic syndrome is an important chronic disorder in children, characterized by heavy proteinuria, hypoalbuminemia, hyperlipidemia and edema
A prospective double blind study of nephrotic syndrome was performed for the International Study of Kidney Disease in Children demonstrated minimal change nephrotic syndrome was the commonest histological lesion and focal segmental glomerular sclerosis (FSGS) as a rare cause in children
Depending on histomorphology cases were diagnosed as Minimal change disease, FSGS, Mesangial proliferative glomeulonephritis, IgM nephropathy, Membranous glomeulonephritis, Membranoproliferative glomeulonephritis, IgA nephropathy and others
Summary
Nephrotic syndrome is an important chronic disorder in children, characterized by heavy proteinuria, hypoalbuminemia, hyperlipidemia and edema. About 90% children with idiopathic nephrotic syndrome have ‘minimal lesion’ on renal histological examination and respond promptly to corticosteroid therapy with remission of proteinuria. In the present retrospective study of over last 15 years, our aims and objectives were to study incidence of renal biopsy in paediatric nephrotic syndrome, correlations between the clinical and histomorphological patterns with clinical outcome in Indian ethnicity children at our tertiary care institute. Nephrotic syndrome is an important chronic disorder in children with clinical manifestation of different histopathological subtypes. An aim of the study was to determine incidence of renal biopsy in paediatric nephrotic syndrome, correlations between the clinical and histomorphological patterns in Indian ethnicity children at our tertiary care institute
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