Padrões morfológicos de lesão glomerular e correlação com achados clinicolaboratoriais de 43 crianças com síndrome nefrótica

Abstract

OBJECTIVES: To evaluate the association between clinical features and laboratory findings with the morphological changes in children with nephrotic syndrome. METHODS: The data were obtained from medical records of 43 children with nephrotic syndrome submitted to renal biopsy. RESULTS: Twenty-eight patients were male (65.1%), aged 1.4-12 years (mean 4.7 ± 3,2). Forty-two patients (97,7%) presented edema, 83.7% oliguria and 32.5% hypertension. The mean of proteinuria was 15.3g/1.73m2 BSA per day and 55.8% presented microscopic hematuria. Renal biopsies showed: proliferative mesangial glomerulonephritis (PMGN) in 37.2%, focal segmental glomerulosclerosis (FSGS) in 27.9%, minimal change disease (MCD) in 25.6%, membranoproliferative glomerulonephritis (MPGN) in 7% and membranous glomerulonephropathy (MGN) in 2.3%. Twenty-six patients (60.5%) were steroid-resistant. Age, sex, hypertension, oliguria, serum urea and creatinine showed no statistically significant change between the patients with PMGN, FSGS and MCD. The patients with PMGN and FSGS showed higher frequency of microscopic hematuria (p < 0.003 and p < 0.03, respectively) and those with FSGS higher level of proteinuria. The patients with MCD were steroid responsive (p < 0.001 versus FSGS and p = 0.047 versus PMGN). CONCLUSION: Age, sex, hypertension, oliguria, serum urea and creatinine did not help to distinguish between the patients with PMGN, FSGS and MCD. The patients with MCD were steroid responsive and less likely to have microscopic hematuria. Patients with FSGS presented higher level of proteinuria.