Clinical Spectrum of Nephrotic Syndrome and Correlation with Histopathology and Immunofluorescence Findings

• Main Authors: S Indupriya, Sridhar Yerram, Chakravarthula Anupama
• Format: Article
• Language: English
• Published: JCDR Research and Publications Pvt. Ltd. 2019-07-01
• Series: Indian Journal of Neonatal Medicine and Research
• Subjects: henoch-schonlein purpura; minimal change disease; proteinuria; systemic lupus erythematosus
• Online Access: http://www.ijnmr.net/articles/PDF/2256/42502_CE[Ra1]_F(SHU)_PF1(AG_SHU)_PFA(SHU)_PB(AG_SHU)_PN(SHU).pdf

Introduction: Nephrotic syndrome is characterised by altered permselectivity of the glomerular filtration barrier which is a common chronic renal disorder in children. In children, it is characterised by oedema, hypoalbuminemia and proteinuria. Aim: To study the clinical profile of nephrotic syndrome in patients and also to study histopathological and immunofluorescence findings and correlation with clinical response to treatment. Materials and Methods: A prospective clinical study was undertaken to study the ‘Clinical Spectrum of Nephrotic Syndrome with special reference to Histopathology and Immunofluorescence. Children with nephrotic syndrome upto the age group of 18 years admitted in the Nephrology ward over a period of one year from January 2008 to December 2008 were included. All patients who met the criteria for nephrotic syndrome (proteinuria >40 mg/m2 /hr serum albumin <2.5 gm/dL, serum cholesterol >200 mg/dL) were eligible for the study. The results were analysed based on the clinical profile histopathology and immunoflorescence findings of the cases. Results: A total of 72 cases with Nephrotic syndrome were included in this study, gross haematuria was noticed in 9 cases (12.5%), hypertension was noticed in 21 cases (29.2% of children).Upper Respiratory Tract Infection (URTI) was seen in 34 cases (77.27%), Urinary Tract Infection (UTI) seen in 03 cases (06.81%), viral fever was seen in 9 cases (12.5%), peritonitis seen in 3 cases (4.2%) and it was seen as the precipitating causes for relapse. Hypertension was seen in 46 cases (63.6%) of steroid resistant group and 24 hour urine protein excretion was more in steroid resistant group. Renal biopsy was done in 29 out of 72 children (42.7%). Minimal change nephrotic syndrome was seen in 11 cases (37.9%) that underwent biopsy irrespective of the indication. Mesangio-proliferative nephrotic syndrome was the most common type in non minimal change nephrotic syndrome, 13 cases (45%) out of 18 cases of nonminimal change nephrotic syndrome (62%). Conclusion: Immunofluorescence is very important in diagnosing secondary nephrotic syndrome and plays a very important role where light microscopy alone cannot help in diagnosis such as IgA and IgM nephropathy, and Lupus nephritis.