Histopathological Pattern of Difficult Childhood Nephrotic Syndrome in A Tertiary Care Centre, Bangladesh
Journal of Pediatric Nephrology,
Vol. 7 No. 3 (2019),
16 Aban 2019
,
Page 1-7
https://doi.org/10.22037/jpn.v7i3.26397
Abstract
Background
The aim of this study was to know the spectrum of histopathology in children who underwent a renal biopsy for difficult NS in a tertiary care pediatric nephrology center.
Method
This prospective observational study took place in Pediatric Nephrology department of Bangabandhu Sheikh Mujib Medical University, Dhaka Bangladesh, from January 2011 to July 2018. Patients presented with difficult pattern of nephrotic syndrome and underwent renal biopsy were enrolled in this study.
Results
Total 140 patients were recruited in this study. Patients with SRNS & nephrotic syndrome with atypical presentation had renal biopsy ; a good number of atypical NS were SDNS. They were grouped into Group A: SRNS, Group B: SDNS, Group C:Nephrotic Syndrome with atypical presentation. Comparison among 3 groups were done. Regarding lab parameters, serum creatinine was raised in 40.6% patients in nephrotic syndrome with atypical presentation and 16.2%in SRNS. In patients with SDNS, MCD (51.3%) was the most common histological pattern followed by MesPGN (33.3%); whereas MesPGN was the commonest histological pattern in SRNS (56.8%) and atypical presentation (54.7%) followed by MCD and FSGS.Most of the patients response to immunosuppressive therapy. In SRNS partial response achieved in 18.9% and CKD developed in 16.2% cases. In comparison, nephrotic syndrome atypical presentation 10.9% patients achieved partial response and 7.8% developed CKD but these are not statistically significant. 5.4% patients of SRNS died.
Conclusion
Mesangioproliferative glomerulonephritis was the most common histopathological diagnosis in patients with SRNS & nephrotic syndrome atypical presentation in our population. MCD is predominant among SDNS.- Minimal Change Disease
- Mesangial Proliferative Glomerulonephritis
- Membreno Proliferative Glomerulonephritis
- Focal Segmental Glomerulosclerosis
- Nephrotic Syndrome. Chronic kidney disease.
How to Cite
References
McEnery PT, Strife CF. Nephrotic syndrome in childhood. Management and treatment in patients with minimal change disease, mesengial proliferation, or focal glomerulosclerosis. Pediatr Clin North Am 1982; 29: 875-894
Sharples PM, Poulton J, White RHR. Steroid responsive nephritic syndrome is more common in Asia. Arch Dis Child 1985; 60: 1139-1148.
Korbet SM. Primary focal segmental glomerulosclerosis. J Am Soc Nephrol 1998; 9: 1333-1340.
McAdams AJ, Valentini RP, Welch TR. The nonspecificity of focal segmental glomerulosclerosis. The defining characteristics of primary focal glomerulosclerosis, mesangial proliferation and minimal change. Medicine (Baltimore) 1997; 76: 42-52.
Ibrahim Seif E, Abdel‑Salam Ibrahim E, Galal Elhefnawy N,Ibrahim Salman M. Histological patterns of idiopathic steroid resistant nephrotic syndrome in Egyptian children: A single centre study. J Nephropathol 2013;2:53‑60
Kidney Disease (2012) Improving global outcomes (KDIGO) glomerulonephritis work group. KDIGO clinical practice guideline for glomerulonephritis. Kidney Int Suppl 2:139–274
Kumar J, Gulati S, Sharma AP, Sharma RK, Gupta RK (2003) Histopathological spectrum of childhood nephrotic syndrome in Indian children. Pediatr Nephrol 18:657–660.
Roy RR, Al Mamun A, Shamsul Haque S M, Muinuddin G, Rahman M. Role of renal biopsy in managing pediatric renal diseases: A midterm analysis of a series at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Saudi J Kidney Dis Transpl(serial online)2017;28(1):125-132.
Edelmann CM, Churg J, Gerber MA, Travis LB (1992) Renal biopsy indications : technique & interpretation. In : Edelmann CM , (ed) Pediatric kidney disease, 2nd edn. Little Brown & Company, Boston , pp.499-527.
Rance CP (1990) When should renal biopsy be done ? Clin Pediatr 29; 653-664.
Vassiliades VG, Bernardino ME (1991) Percutaneous renal & adrenal biopsies. Cardiovasc Intervent Radiol 14;50-54.
Reshi AR, Bhat MA, Najar MS, et al. Etiological profile of nephrotic syndrome in Kashmir. Indian J Nephrol 2008; 18: 9-12.
Bakr A, Eid R, Sarhan A, et al. Fifteen years of kidney biopsies in children: A single center in Egypt. Saudi J Kidney Dis Transpl 2014;25: 1321-7.
Hadidi R, Hadidi M, alDabbas M. Spectrum of biopsy-proven kidney disease in children at a Jordanian hospital. Saudi J Kidney Dis Transpl 2014;25:680-3.
Abdelraheem MB, Ali el-TM, Mohamed RM, et al. Pattern of glomerular diseases in Sudanese children: A clinico-pathological study. Saudi J Kidney Dis Transpl 2010;21:778-83.
Gulati S, Sengupta D, Sharma R, Sharma A, Gupta RK, et al. Steroid resistant nephrotic syndrome: role of histopathology.Indian Pediatrics,2006; 43:55-60.
Coppo R, Gianoglio B, Porcellini MG, Maringhini S: Frequency of renal diseases and clinical indications for renal biopsy in children (report of the Italian National Registry of Renal Biopsies in Children). Group of Renal Immunopathology of the Italian Society of Pediatric Nephrology and Group of Renal Immunopathology of the Italian Society of Nephrology. Nephrol Dial Transplant, 1998; 13: 293–97
Rychlik I, Jancova E, Tesar V et al: The Czech registry of renal biopsies. Occurrence of renal diseases in the years 1994-2000. Nephrol Dial Transplant, 2004; 19: 3040–49
Rivera F, Lopez-Gomez JM, Perez-Garcia R: Clinicopathologic correlations of renal pathology in Spain. Kidney Int, 2004; 66: 898–904
Ko KW, Ha IS, Jin DK et al: Childhood renal diseases in Korea. A clinicopathological study of 657 cases. Pediatr Nephrol, 1987; 1: 664–69
Al-Rasheed SA, al-Mugeiren MM, al-Salloum AA: Childhood renal diseases in Saudi Arabia. A clinicopathological study of 167 cases. Int Urol Nephrol, 1996; 28: 607–13
Bircan Z, Yavuz Yilmaz A et al: Childhood idiopathic nephrotic syndrome in Turkey. Pediatr Int, 2002; 44: 608–11
Simpson AK, Wong W, Morris MC: Paediatric nephrotic syndrome in Auckland, New Zealand. J Paediatr Child Health, 1998; 34: 360–62
Srivastava RN. 50 years of nephrotic syndrome in children, and hereafter. Indian Pediatr
;50:107-10.
Jennette JC, Olson JL, Schwartz MM, Silva FG (eds): Heptinstall’s Pathology of the kidney,
Volumes 1 and 2, 6th edition,: Lippincott Williams and Wilkins, Philadelphia; 2007. p.126-54
Chanchlani R and Parekh RS (2016) Ethnic Differences in Childhood Nephrotic Syndrome. Front. Pediatr. 4:39. doi: 10.3389/fped.2016.00039
Hu YC, Feng YX, Lv XA, Wang R. A clinical and pathological analysis of 3722 renal biopsy
specimens from adults with primary glomerular disease in Shandong province, China. WIMJ Open 2014;1:57.
Mendelssohn DC, Cole EH. Outcomes of percutaneous kidney biopsy, including those of
solitary native kidneys. Am J Kidney Dis 1995;26:580-5.
- Abstract Viewed: 270 times
- PDF Downloaded: 174 times