Focal Segmental Glomerulosclerosis as the Leading Cause of Idiopathic Nephrotic Syndrome: A different spectrum revealed by mandatory renal biopsy in all patients

Abstract

Introduction: Idiopathic nephrotic syndrome (INS) is associated with varied glomerular lesions. The evidence so far confirms a higher incidence of minimal change disease (MCD) than other subtypes in children. Different newer trials and review literatures suggest a 2-fold increase in the incidence of focal segmental glomerulosclerosis (FSGS) in recent decades. Objective: To determine the histopathology of idiopathic nephrotic syndrome following mandatory renal biopsy Method: The patients attending the Department of Paediatric Medicine with a diagnosis of INS were selected for the study. A confirmatory diagnosis was established. Thereafter all patients underwent a mandatory renal biopsy (after exclusion of any absolute contraindication) and histopathology examination. Different findings were compared between MCD and Non-MCD groups (those having histological lesion other than MCD). Results: There were 52 children suffering from nephrotic syndrome (NS) whom we included in our study. The most frequently noted glomerular lesion was FSGS in 45% followed by MCD in 27%, mesangioproliferative glomerulonephritis (MSGN), membranoproliferative glomerulonephritis (MPGN) and membranous glomerulonephritis (MGN). The incidence of relapse was significantly higher in the Non-MCD group (p=0.02). Conclusions: In our study, a mandatory renal biopsy in all patients found FSGS to be the most common glomerular lesion among paediatric age group patients suffering from INS. (Key Words: Focal segmental glomerulosclerosis, idiopathic nephrotic syndrome, renal biopsy) DOI: http://dx.doi.org/10.4038/sljch.v45i2.7979