SUN-467 CLINICOPATHOLOGICAL SPECTRUM OF RENAL BIOPSIES IN UNIVERSITY CHILDREN’S HOSPITAL IN DAMASCUS

Abstract

Renal biopsy is an important tool for establishing the histological diagnosis and prognosis, as well as guiding therapy of renal disease in children and adults. There is great variation in epidemiology of renal histopathology all over the world, due to differences in race, socioeconomical difference and policy of performing kidney biopsy in children. There are very few renal pathology studies available in the literature from developing world, so we performed this study to identify the distribution of histopathological types of renal diseases in patients in Children’s Hospital in Damascus, and describe the clinicopathological correlation, and its effect on the choice of treatment, for establishing the important indications for renal biopsy. A Descriptive retrospective study carried out in Children’s Hospital in Damascus, included all patients admitted and had percutaneous kidney biopsy, in a period of 6 years, from January 2011 to December 2016. A sample was considered adequate if more than ten glomeruli were present. The specimen was examined only under light microscopy and immunofluorescence, as electron microscopy is not available at our center. We collected the data, which were discussed and compared with similar studies in the literature. The study includes 105 patients had kidney biopsy, with slight male dominance (52%) and median age 6 years, ranged from 40 days to 14 years. All patients tolerated the biopsy well, without important complications. Nephrotic Syndrome was the most common indication for kidney biopsy (62%), followed by Persistent Isolated Glomerular Hematuria (13%) and Systemic Lupus Erythematosus (12.5%) and Acute Nephritic Syndrome (8.5%). Steroid-resistant Nephrotic Syndrome was the commonest indication for biopsy in Nephrotic Syndrome patients (51%). Focal Segmental Glomerulosclerosis was the commonest histopathological diagnosis in Nephrotic Syndrome patients (45%), then Minimal Change Disease (32%). In Persistent Isolated Glomerular Hematuria patients (14 cases), the biopsy was normal in (50%), and revealed IgA Nephropathy in (29%). In Systemic Lupus Erythematosus patients (13 cases), the most common histopathological type was Lupus Nephritis type IV (38%). Renal biopsy is a safe procedure in children and occupies a fundamental position in the management of kidney diseases. The most common indication for the renal biopsy in children remains Nephrotic Syndrome, mainly Steroid-resistant Nephrotic Syndrome, and the commonest histopathological diagnosis in Nephrotic Syndrome patients who had kidney biopsy is Focal Segmental Glomerulosclerosis. Biopsy had no therapeutic effect in Persistent Isolated Glomerular Hematuria, so it is not urgent procedure in these cases. It is important to do renal biopsy in Systemic Lupus Erythematosus cases in children, which help in guiding therapy and follow it.