Trends of Histopathology in Childhood Nephrotic Syndrom
Iraqi Postgraduate Medical Journal,
2009, Volume 8, Issue 1, Pages 47-55
Nephrotic syndrome (N.S.) is clinical manifestation of different histopathological subtypes
This study was conducted to analyze the trend of histopathological subtypes in idiopathic nephrotic syndrome.
A prospective study was performed from January 2004 to May 2005, at Central child teaching hospital and Al-karama teaching hospital involving 113 patients aged up to 18 years with nephrotic syndrome. The following parameters were studied (age, gender, initial episode, relapse, predisposing factors, positive family history of nephrotic syndrome, clinical presentation and investigation, treatment and complication).
One hundred thirteen patients enrolled in this study, 71(63%) were males and 42(37%) were females, male to female ratio was 1.7/1. 23(20.3%) patients were with initial attack of nephrotic syndrome, while 90(79.6%) patients with relapse. Age at onset ranged between 0.7-14 (median 2.3) years. Family history of nephrotic syndrome was found in 8 (7%) patients. Biopsies was done in 74(65%) patients. 36(48.6%) patients showed focal segmental glomerulosclerosis. 17(22.9%) patients showed minimal change disease.10(13.5%) patients showed membranoproleferative glomerulonephritis. Other histopathological sub types were 6(8%) patients with mesangioproleferative glomerulonephritis, 3(4%) patients with global masengial sclerosis, and 2 (2.7%) patients with amyloidosis.
This trend of histopathologic patterns has profound prognostic significance and has significant implications in the management of childhood nephrotic syndrome. There is shift toward an increasing incidence of focal segmental glomerulosclerosis and to lesser extent, the membranoproleferative glomerulonephritis in Iraqi children presenting with idiopathic nephrotic syndrome. Our finding is in agreement with the recommendation of performing renal biopsies on children with idiopathic nephrotic syndrome who are steroid dependant in addition to those who are steroid resistant particularly before starting cytotoxic medication.
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