Histopathological spectrum of childhood nephrotic syndrome in Pakistan

Clin Exp Nephrol. 2009 Dec;13(6):589-93. doi: 10.1007/s10157-009-0216-0. Epub 2009 Jul 28.

Abstract

Background: There is no information in international literature on the pattern of glomerulopathies in children with idiopathic nephrotic syndrome (INS) in Pakistan. We undertook this study to determine the pattern of glomerulopathies based on renal biopsies studied by light (LM), immunofluorescence (IF), and electron microscopy (EM).

Methods: The study was conducted at Sindh Institute of Urology and Transplantation (SIUT), Karachi over 12 years (1996-2008). All children (<or=18 years) with INS in whom renal biopsy was performed were included. Renal biopsies were studied by LM, IF, and EM.

Results: Of 538 children, 347 (64.4%) were male and 191 (35.5%) were female. Mean age was 9.79 +/- 4.59 years. The histopathological lesions comprised: minimal change disease (MCD) and its variants, 43.8%; focal segmental glomerulosclerosis (FSGS), 38.14%; membranous glomerulonephritis (GN) (MGN), 7.96%; mesangioproliferative GN (MesPGN), 4.81%; mesangiocapillary GN (MPGN), 3.14%; IgA nephropathy (IgAN), 1.11%; and other rare lesions.

Conclusion: MCD and its variants are the leading cause of overall INS in children, followed by FSGS, which is the predominant pathology in steroid-resistant and adolescent nephrotic syndrome (NS). Our data are in accordance with recent series from around the world with similar biopsy indications. The study defines the true pattern of glomerulopathies in childhood INS for the first time in Pakistan.

MeSH terms

  • Adolescent
  • Biopsy
  • Child
  • Child, Preschool
  • Female
  • Fluorescent Antibody Technique
  • Glomerulonephritis, IGA / pathology
  • Glomerulonephritis, Membranous / pathology
  • Glomerulosclerosis, Focal Segmental / pathology
  • Humans
  • Infant
  • Kidney / pathology
  • Male
  • Microscopy, Electron
  • Nephrotic Syndrome / drug therapy
  • Nephrotic Syndrome / pathology*
  • Pakistan
  • Steroids / therapeutic use

Substances

  • Steroids