Histopathological spectrum of childhood nephrotic syndrome in Indian children

Abstract

Nephrotic syndrome in children is a clinical manifestation of different histopathological subtypes. There is a paucity of recent large studies dealing with the histopathological spectrum from developing countries. A prospective study was performed from January 1990 to December 2000 at our center, involving 600 children (with age of onset up to 16 years) with idiopathic nephrotic syndrome (INS). The objectives were: (1) to study the histopathological distribution of different subtypes of INS and (2) to compare the clinical and biochemical parameters at the time of diagnosis of minimal change disease (MCD) with non-MCD subtypes. For the purpose of this study we analyzed only those children with INS who underwent biopsies. The study group included 290 children in which adequate biopsy reports were available. There were 213 males and 77 females. Mean age at onset of INS was 7.9+5.1 years. Facial edema was found in 286 (98.6%), microhematuria in 120 (41.3%), gross hematuria in 7 (2.5%), and hypertension in 77(26.8%) patients. All patients of the study group were seronegative for HBsAg and HIV. Focal and segmental glomerulosclerosis (FSGS) was the most common histopathological subtype, occurring in 110 of 290 children (38%). Other subtypes included MCD in 95 children (32%), membranoproliferative glomerulonephritis (MPGN) in 44 children (15%), mesangioproliferative glomerulonephritis in 33 children (11%), membranous glomerulonephritis in 5 children (2%), and diffuse mesangial sclerosis in 3 children (1%). In children under 8 years of age, MCD was the most common entity, whereas FSGS predominated in children with age at onset greater than 8 years. The age at onset of nephrotic syndrome was significantly higher in the non-MCD group than the MCD group. The incidence of hypertension, microhematuria, and gross hematuria was significantly lower in the MCD group. MCD remains the most common histopathological subtype in Indian children with INS and onset under 8 years of age. The incidence of MPGN continues to be high. MCD can be differentiated from non-MCD subtype by younger age at onset, absence of hypertension, and absence of microscopic hematuria.

Etiological profile of nephrotic syndrome in Kashmir

“…FSGS was the second most common cause. This is in accordance with observations made by others29 and some reported it as the most common cause in children above 8 years of age 30. The incidence of primary and secondary glomerular diseases is similar to that found in a study conducted in Iraq 18…”

Trends in the histopathology of childhood nephrotic syndrome in Ibadan Nigeria: preponderance of idiopathic focal segmental glomerulosclerosis

“…In interpreting and comparing histologic reports from different centres, the indications for renal biopsy, steroid exposure, the time periods of the study which have been shown to produce varying results over decades in the same location [20, 26, 35] need to be critically considered. Other important considerations are patient population in terms of age [36–38], race and whether native or transplant kidneys are studied. All the patients studied were black Nigerians and the kidneys were all native kidneys.…”

Spectrum of biopsy proven renal disease in South Asian children: Two decades at a tropical tertiary care centre

“…Adequate biopsy specimen was defined as presence of at least five glomeruli in the specimen on LM, similar to previously published studies. 4,5 Nephrotic syndrome was defined as oedema, proteinuria >40 mg/m 2 per h on timed sample and hypoalbuminaemia <2.5 g/dL. ANS was defined as haematuria, oliguria, oedema, hypertension (≥95th centile for age) and GFR < 75 mL/min per 1.73 m 2 by Schwartz's formula.…”