The Spectrum of Histopathological Lesions in Children Presenting with Steroid-Resistant Nephrotic Syndrome at a Single Center in Pakistan

Abstract

Steroid-resistant nephrotic syndrome (SRNS) is a common problem in pediatric nephrology practice. There is currently little information in the literature on the spectrum of histopathologic lesions in children presenting with SRNS in Pakistan. This study was designed to determine the histopathologic lesions in children presenting with SRNS at our center. The study was conducted at the Histopathology Department, Sindh Institute of Urology and Transplantation (SIUT) from January 2009 to August 2011. All children (≤16 years) presenting with SRNS, in whom renal biopsies were performed, were included. Their demographic, clinical, laboratory, and histopathological data were retrieved from files and original renal biopsy forms. The results were analyzed by SPSS version 10.0. A total of 147 children were included. Of these, 91 (61.9%) were males and 56 (38.1%) females, with male-to-female ratio of 1.6 : 1. The mean age was 7.03 ± 4.0 years (range: 6 months–16 years). The histopathological lesions seen on renal biopsies comprised of focal segmental glomerulosclerosis (FSGS) (38.5%), followed by minimal change disease (MCD) (23.2%), IgM nephropathy (IgMN) (13.6%), idiopathic mesangial proliferative GN (10.2%), membranous GN (8.2%), and mesangiocapillary GN (4.8%). Our results indicate that FSGS is the predominant lesion in children with SRNS, followed by MCD and IgMN.

The prevalence and clinicopathological profile of IgM nephropathy in children with steroid-resistant nephrotic syndrome at a single centre in Pakistan

“…The frequency of SRNS varies throughout the world ranging from 10% to 20% 1. We have earlier found steroid-resistant pattern in 30% of our children with idiopathic nephrotic syndrome (INS), who underwent renal biopsy 2.…”

“…Steroid-resistant nephrotic syndrome (SRNS) is a common problem in paediatric nephrology practice and is a difficult therapeutic challenges for the paediatric nephrologist 1. The frequency of SRNS varies throughout the world ranging from 10% to 20% 1.…”

R: Histological patterns of idiopathic steroid resistant nephrotic syndrome in Egyptian children: A single centre study

“…The authors have also analyzed certain glomerular and tubulointerstitial changes on renal biopsies, which might have influenced the response to steroids in these children. ISRNS accounts for 10-30% of nephrotic syndrome (NS) in children around the world (2,3). It poses significant diagnostic and therapeutic challenges to both the nephrologists and the nephropathologists.…”

Renal Histopathology in Childhood Nephrotic Syndrome at National Institute of Kidney Diseases and Urology, Dhaka, Bangladesh– an experience of one decade

“…However, both of these studies focused on high-risk populations that were either steroid dependent or frequent relapsers, in which a higher incidence of FSGS was found. 11,12 Results of this study demonstrated thatmesangial proliferatve Another consideration for the rise in the incidence of mesangial proliferatve glomerulonephritis is a potential increase in the age of the patients admitted in our center more than 8 to 12 years (67.39%). Our results are similar with other study that the increasing incidence of mesangial proliferatve glomerulonephritis was limited to patients older than eight years of age.…”