Histopathology Interstitial Severity Index Associated with Glomerular and Tubular Severity Index in Nephrotic Syndrome Patients

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Introduction: Nephrotic syndrome is characterized by massive proteinuria due to leakage of glomerular basal membrane, and subsequent process in tubular and interstitial tissue. It should be elucidated whether the severity of histopathological lesions in compartments of kidney tissue play a role and whether lesion in those compartments associated one to another. Aim: The study aims to correlate severity histopathologic lesions among compartments in kidney tissue. Method: All patients with nephrotic syndrome were biopsied and the cores were stained with Hematoxylin-Eosin, PAS, Masson’s Trichrome to look at glomerular, tubular, interstitial and vascular involvements. Glomerular abnormalities including mesangial hypercellularity, endocapillary hypercellularity, membranous; tubular, interstitial, and vascular severities were scored according to type, activity, severity and distribution in histopathologic features. Results: This study included 46 patients consisted of 16 (34.8%) males and 30 (65.2%) females, aged 26 ± 10 years, SBP 121.7 ± 13.10 and DBP 78.21 ± 7.80 mmHg, diagnosed with 14 lupus and 32 non-lupus nephrotic syndrome. Histopathologic abnormalities showed glomerular index was 4.26 ± 2.34, tubular index was 3.09 ± 1.90, interstitial index was 3.02 ± 1.48, vascular index was 0-3, pathologic index was 10.56 ± 4.54. There was significant correlation of severity index between interstitial and glomerular lesions (R=0.49, P=0.001), and between interstitial and tubular lesions (R=0.45, P=0.002). However, there were no significant correlations of severity index between interstitial and vascular lesions, and glomerular and tubular lesions. Conclusion: There are significant correlations of severity index between interstitial with glomerular and tubular lesions. It may implicate that histopathological process in interstitial tissue plays a central role in the pathogenesis of proteinuria in nephrotic syndrome.