MESANGIAL PROLIFERATE GLOMERULONE PHRITIS PRESENTING AS NEPHROTIC SYNDROMS IN CHILDHOOD

Abstract

Despite two controlled investigations of childhood nephrosis totalling 373 patients, there remains a paucity of detailed clinical and pathologic information of mesangial proliferative glomerulonephritis with the nephrotic syndrome in childhood. We had the opportunity to study 8 patients with the nephrotic syndrome, the mean age of onset was 7.2 years with a range of 3.5 to 12.2 years; there were 5 males and 3 females. All patients had renal biopsies which were studied by light, electron and immuno-fluorescent microscopy. The pathologic findings with hematoxylin-eosin showed predominant mesangial proliferation in all patients. Immunofluorescences revealed positive mesangial fluorescence to immunoglobulin (Ig) M in 8 patients, 6 of 8 had C3 complement and fibrin/fibrinogen, 4 of 8 had IgG. Electron microscopy showed electron dense deposits in the mesangium. Seven of the 8 patients were steroid sensitive and frequent relapsing nephrotics. One is steroid resistant for 1.5 years but renal function remained normal. It has been assumed that children with steroid sensitive nephrotic syndrome with the onset before 5 years of age have idlopathic nephrotic syndrom: (I.N.S.), 2 of the present patients ware leas than 5 years at onset; therefore, this may no longer be an accurate assunption. Therefore previous studies of steroid sensitive nephrotic syndrome with onset less than 5 years without renal biopsies may not fulfill the pathologic criteria of I.N.S.