Changing Histopathological Trends in Idiopathic Steroid Resistant Nephrotic Syndrome in Pediatric Population

Abstract

Objective: This study aims to determine the most prevalent histopathological subtype of nephrotic syndrome in children and assess the response to corticosteroids therapy in different histological patterns.

Methodology: A cross-sectional analysis of 64 patients was conducted from february 2018 to june 2019 at  Pakistan Institute of Medical Sciences Hospital (PIMS), Islamabad. Patients were clinically assessed and investigated using criteria determined by International Study of Kidney Disease in Children (ISKDC). Renal biopsies were performed where indicated and samples were examined with the help of light microscopy and immunofluorescence. IBM SPSS 24 and Excel 2010 were used for data interpretation and illustration.

Results: The study comprised of 64 patients including 32 (50%) females and 32 (50%) males, ranging from 2 years to 12 years, with a mean age of 6.78 years. The results showed FSGS (28.13%)  and MCD (28.13%)  as the most common pattern on histopathology  followed by MPGN (15.63%), Mesengioproliferative Glomerulonephritis (9.38%), Membranous glomerulonephritis (9.38%), Diffuse Proliferative glomerulonephritis (DPGN) (3.13%), Lupus Nephritis (LN) (3.13%), IgM nephropathy (IgMN) (3.13%). 87.5%  children were observed to be resistant to corticosteroid therapy, whereas, the rest of the 12.5% patients responded to corticosteroid treatment.

Conclusion: Resistance to steroids has become more prevalent in all variants of nephrotic syndrome in children. FSGS and Minimal change disease are the most frequently seen histopathological patterns observed in the pediatric population of  Pakistan, having Steroid resistant nephrotic syndrome (SRNS). Furthermore, an increase in the frequency of FSGS was observed in our population, in comparison to prior studies.