Histopathological Patterns in Childhood Steroid Resistant Nephrotic Syndrome

Abstract

Objective: To determine the frequency of various histopathological lesions in children with steroid resistant nephrotic syndrome (SRNS) presenting to the Children's Hospital & the Institute of Child Health, Multan.

Study Design: Retrospective observational study

Place and Duration of Study:  This study was conducted at the Department of Paediatric Nephrology, The Children’s Hospital and The Institute of Child Health, Multan, Pakistan from October 2005 to December 2012.

Materials and Methods: Medical record of 152 children with SRNS, who were biopsied, was reviewed. All SRNS patients, both initial steroid resistant and late non-responders were included in the study.

Results: Out of the total 152 patients, 98 (64.5%) were males and 54 (35.5%) females, with a male to female ratio of 1.8: 1. Mean age and standard deviation of patients was μ 8.11 + 3.58 years with age range of 1 to 15 years. Histopathological spectrum showed focal segmental glomerulosclerosis (FSGS) as the commonest (59; 38.81%) lesion followed by mesangioproliferative glomerulonephritis (MesPGN) (40; 26.31%), minimal change disease (MCD) (35; 23.02%) and mesangiocapillary glomerulonephritis (MCGN) (13; 08.55%). Four (2.63%) patients had membranous nephropathy. One patient of renal amyoidosis was also diagnosed on renal biopsy.

Conclusion: Overall FSGS was the commonest lesion followed by MesPGN, MCD, and MCGN. IgMN was an associated finding in 25% cases of MesPGN. FSGS was significantly more common among children >10 years. MCD was significantly more common among children 1-5 years. MesPGN and MCGN were significantly more common among children >5 years.