Histopathologic Diagnosis and Outcome of Renal Biopsied Pediatric Nephrotic Syndrome.
- Author:
Hye Jeon CHUNG
1
;
Suk YOUN
;
Sung Do KIM
;
Byoung Soo CHO
Author Information
1. East-West Kidney Disease Research Institute, College of Medicine, Kyung-Hee University, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Nephrotic syndrome;
Renal biopsy;
Methylprednisolone pulse therapy
- MeSH:
Biopsy;
Child;
Complement System Proteins;
Diagnosis*;
Hematuria;
Humans;
Hypertension;
Immunoglobulin A;
Methylprednisolone;
Nephrotic Syndrome*;
Pediatrics;
Retrospective Studies;
Seoul;
Treatment Outcome
- From:Journal of the Korean Society of Pediatric Nephrology
2005;9(2):149-158
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: To determine the histological findings and treatment outcome in cases of childhood nephrotic syndrome which required renal biopsy. METHODS: We retrospectively reviewed the clinical, laboratory, pathologic findings and therapeutic outcomes of 169 nephrotic children who received a renal biopsy at the Department of Pediatrics, Kyunghee Medical University Hospital, Seoul from 1984 to 2004 over a period of 21 years. The renal biopsy was performed in nephrotic children who showed atypical features at presentation, or needed cytotoxic therapy because of frequent-relapsing, steroid-dependent, or steroid-resistant nephrotic syndrome(SRNS). RESULTS: Minimal change disease(MCD) was found in 52.1% of the patients, followed by diffuse mesangial proliferation(33.1%), focal segmental gomerulosclerosis(5.3%), membranoproliferative glomerulonephritis(2.4%), membranous nephropathy(2.4%), and IgA nephropathy(1.8 %). In MCD children, 14.8% had hematuria, 22.7% had hypertension, 5.7% showed decreased renal function, and no patient was found to have an abnormal complement level. Among patients diagnosed with diseases other than MCD, 43.2% had hematuria, 21.0% was found to be hypertensive, 7.4% of children showed decreased renal function and only 3(3.7%) had decreased complement level; the rates of hematuria and SRNS were found to be significantly higher than MCD patients. Among 37 SRNS patients, 30(81.0%) showed a final remission state with long-term steroid therapy, including methylprednisolone pulse therapy, over 4 months, with or without cytotoxic therapy. CONCLUSION: Almost half of the cases of childhood nephrotic syndrome requiring renal biopsy were not diagnosed with MCD. Among atypical features, hematuria and steroid-resistance would be the most probable indicators for a diagnosis other than MCD. Even in patients with SRNS, long-term methylprednisolone pulse therapy may result in a good remission rate.
