Mesangial hypercellularity in children: presenting features and outcomes

Abstract

Mesangial hypercellularity (MH), in the absence of sclerosis or immune deposition, was a common finding on renal biopsy in our center. We studied 66 children with predominant MH. Among all patients older than 2.7 years, blood pressure (BP) percentile and glomerular filtration rate (GFR) remained stable. Serum albumin (Alb) trended higher (3.0+/-0.2 start vs. 3.4+/-0.2 end g/dl, p=0.06) and urine protein/creatinine lower (4.2+/-0.9 start vs. 2.3+/-0.9 end mg/mg, p=0.18) at the end of the study period. The proportion with stage 1 CKD remained constant: 94% start vs. 92% end. At end, Alb was lower in patients referred for nephrotic syndrome (NS): 4.4+/-0.3 hematuria vs. 4.2+/-0.2 proteinuria vs. 2.8+/-0.3 NS g/dl, p<0.05 vs. both. Alb was lower (p=0.03) and urine protein/creatinine trended higher in patients with diffuse foot-process fusion (FPF). Twenty-five percent of patients with focal FPF developed NS, all had relapses, and 63% were steroid sensitive (SS). All but one with diffuse FPF presented with NS; 86% had relapses (mean 1 year) and 63% were SS. GFR trended higher at the end in those with matrix thickening (mat) (119.6+/-4.7 no mat vs. 129.1+/-2.6 mat ml/min per 1.73 m2, p=0.1). Those without mat were less SS (59% no mat vs. 80% mat) and were more likely to require alkylating agents (Alk) for NS. Among those with positive immunofluorescence (IF), 82% had immunoglobulin M (IgM) alone; those with positive IF were more SS and needed Alk for NS. MH predicts a favorable prognosis. FPF predicts NS and multiple relapses.

C1q nephropathy in the pediatric population: pathology and pathogenesis

“…The other 9 patients had isolated DMP; ultimately, complete or partial remission was achieved in all of these patients. If one excludes the subset of patients with FSGS and DMP, the outcomes of these patients are very good and compare favorably with both historical reports of outcomes in NS with DMP and recent publications of patients with isolated mesangial proliferation [59][60][61].…”

Impact of Immunofluorescence on the Histological Pattern of Pediatric Kidney Biopsies from Northern Pakistan

“…We feel this histological pattern cannot be considered as a variant of MCD due to distinct morphological pattern though its clinical behavior mimics MCD to some degree. 12 IMF however has altered the frequency of MCD which has changed from 24% (100/415) to 17% (29/170), a change of 7%, FSGS 18.3% (76/415) to 15.88% (27/170), and a change of 2.42%. MPGN 17.35% (72/415) to 7.65% (13/170), a change of 10%, when comparing the two series, that is, 170 versus 415.…”

Infant with gross hematuria and nephrotic syndrome: answers

“…Mutations in PLCE1, WT1, and LAMB2 are known causes of isolated DMS, DMS as part of DDS, or Pierson syndrome [5,7,8]. DMS and DMH can have overlapping features, such as increased mesangial matrix [2,4,14]. In the case described here, mild mesangial sclerosis was noted.…”

“…Full remission was not achieved with an 8-week course of steroid. She continued ACEi and began treatment with tacrolimus [1,2]; full remission was then achieved. At her last follow-up, she had normal renal function, no proteinuria, no hypertension, and no recurrence of hematuria.…”