Clinical, Biochemical and Histopathological Profile of Adult Nephrotic Syndrome Patients in a Tertiary Care Hospital

Abstract

BACKGROUND:The nephrotic syndrome is recognized as an independent entity of renal disease for over half a century. 1 Causes of nephrotic syndrome varies with age, time period, geographical location and race. In children, minimal change nephrotic syndrome is the commonest 2 ; however, membranous nephropathy is most frequent in adults. 3 As it commonly affects the younger age group and is associated with high morbidity and mortality, there is a need to understand and diagnose the disease at an early stage. Hence, this study has been done to identify the clinical presentation, biochemical parameters and histopathology associated with nephrotic syndrome in adults and its subtypes. OBJECTIVE: To study the clinical, biochemical and histopathological profile of patients with Adult Nephrotic Syndrome admitted in our tertiary care hospital. METHODS: Prospective study of 100 patients with Adult Nephrotic Syndrome admitted in our tertiary care hospital were screened with facial puffiness and pedal edema. They were tested for urine proteinuria, urine protein creatinine ratio or 24 hour urine protein estimation. Later renal biopsy was done for all patients to stratify the subtypes. RESULTS: In this study, males were predominantly affected. Most common presenting complaints were facial puffiness and pedal edema. Systolic BP was increased in 96% of patients and diastolic BP was elevated in 50% of patients. Serum LDL and TGL were elevated in nephrotic syndrome. In young patients less than 40 years Focal Segmental Glomerulosclerosis (FSGS) is the commonest type, then Membrano Proliferative Glomerulo Nephritis (MPGN) and Minimal Change Disease (MCD). In individuals more than 40 years, membranous nephropathy was predominantly seen followed by FSGS. CONCLUSION: There is a changing trend in primary nephrotic syndrome and FSGS was found to be the commonest subtype. Male preponderance was noticed and also FSGS was found to be more common in younger adults. Most patients in this study were found to have high BP at presentation. Serum creatinine was markedly elevated in patients with IgA Nephropathy and FSGS subtype. Most patients with FSGS who had elevated creatinine were found to have significant protein loss in urine. Lipids were observed to be elevated in all the subtypes, most significantly in the IGA nephropathy type.