Pathologic analysis of 170 infants with glomerular diseases

Abstract

Objective From January 1990 to December 2000 in the 281st Hospital of People′s Liberation Army, 170 attempts of percutaneous renal biopsy were performed in infant patients. In this report, the clinic presentations and pathological features of glomerular diseases in infants were analyzed retrospectively, and pathological classification was compared between infant patients and adult patients. Method Of 170 infant patients, 127 were boys and 43 were girls. The mean age at the renal biopsy was 31.2 months (30 days to 36 months). The pathological classification was made according to the WHO criteria of 1982 and to the criteria of Pathological Coordinating Group of the Chinese Society of Nephrology in 1985. The clinical diagnosis was made according to the criteria of Collaboration Group of the Chinese Society of Pediatric Nephrology. One hundred and fifty patients with infantile nephritic syndrome were divided into the simple nephrosis group (n=133) and the nephritic nephrosis group (n=17). All patients were treated with the combination of prednisone [1.5—2 mg/(kg·d)], mustargen (0.06—0.09 mg/kg, once every other day), persantime, heparin and and Chinese herbs according to the syndrome type. Result The primary glomerulonephritis accounted for 96.5% of the total renal biopsy samples, secondary glomerulonephritis 1.8%, and hereditary nephritis 1.8%. The mesangial proliferative glomerulonephritis accounted for 40.9% of the primary glomerulonephritis, minimal-change disease 22.6%, immunoglobulin M nephropathy 17.7%, endocapillary proliferative glomerulinephritis 5.5%, membranous nephropathy 4.9%, minor-lesion nephropathy 3.7%, immunoglobulin A nephropathy 3.0%, focal segmental glomerulosclerosis 1.2% and C1q nephropathy 0.6%. Two 2 patients were diagnosed to have Henoch-Schonlein purpura nephritis and 1 patient to have drug induced renal injury. Congenital nephrotic syndrome was found in 3 patients. Among 150 patients with nephrotic syndrome, 133 had simple nephrosis, the remaining 17 patients had nephritic nephrosis. Acute glomerulonephritis was diagnosed in 8 patients, persistent glomerulonephritis in 2 patients, and isolated hematuria or proteinuria in 4 patients. The complete remission rate of the simple nephrosis group was 100 %, which was significantly higher than that of the nephritic nephrosis (64.8%, χ2=28.325, P<0.01). The therapeutic effects of minimal change disease and minor lesion nephropathy and mesangial proliferative glomerulonephritis patients were significantly superior to those of mesangial hypercellularity, crescent, tuft adhesion, mesangial sclerosis, global sclerosis, tubular atrophy, and interstitial fibrosis patients (χ2=51.45, P<0.01). Conclusion Primary glomerulonephritis dominated infantile glomerular diseases. Mesangial proliferative glomerulonephritis and minimal change disease were the most common pathological type of the primary glomerulonephritis. Nephrotic syndrome was the most common clinical type of the primary glomerulonephritis, among whom simple nephrosis was predominant. Henoch-Schonlein nephritis was the most common type of the secondary glomerulonephritis. The common cause of the hereditary nephritis was congenital nephrotic syndrome, which was found only in the infants and newborns younger than 6 months. The percutaneous renal biopsy is a useful diagnostic aid and can be used as a therapeutic guidance even in infantile patients with renal diseases. Key words: Glomerulonephritis; Kidney; Biopsy; Pathology