NEEDLE BIOPSY IN CHILDREN WITH NEPHROSIS

Abstract

Needle biopsy of the kidney was done in 20 children with nephrosis for estimation of degree of glomerular damage in the early stage of the disease and of its change after intensive adrenal steroid therapy. The mean number of glomeruli per biopsy was 18.7 with a standard deviation of ±8.4 and a range of 6 to 42. Glomerular involvement was seen in 100% of cases and in 5 to 100% of nephrons in material obtained at biopsy. Thickening of capillary basement membrane was present in 90% of cases and 32.4% of glomeruli; cellular proliferation in 65% of cases and 17.3% of glomeruli; hyalinization in 55% of cases and 8.9% of glomeruli; and fibrosis in 65% of cases and 12.8% of glomeruli. Lesions of various types were simultaneously present in most cases, but thickening of the capillary basement membrane was the predominant one. The nephrotic syndrome was observed in cases having histologic changes similar to those described as membranous, chronic azotemic, proliferative and lobular glomerulonephritis. Adrenal steroid therapy was given to induce a complete clinical-biochemical remission of the nephrotic syndrome. It occurred, usually but not always after the appearance of induced Cushing's syndrome, and was observed in 81.2% of children treated with adrenal steroids. Histologic improvement was observed in 90% of patients who had biopsy taken before and after therapy. Four patients of the total group (20%) showed a marked decrease of glomerular lesions. Administration of a maintenance dose of steroid hormone was necessary for prolonging biochemical remission of the nephrotic syndrome. Administration of prednisone seemed to decrease cellular proliferation and to arrest the progress from thickening of capillary basement membrane to obliteration of the glomerular capillary. The impression was gained that clinicalbiochemical and anatomic improvement of the nephrotic syndrome was not permanent unless spontaneous healing occurred, and that longer observation is required to evaluate the effect of prednisone.