Farkhanda Hafeez, Farooq Rasool, Tahira Hamid.
Renal biopsy in childhood Nephrotic Syndrome.
J Coll Physicians Surg Pak Jan ;12(8):454-7.

Objective: To study the histopathological pattern in childhood nephrotic syndrome who underwent biopsy, and the safety of the procedure. Design: A prospective study. Patients and Duration of Study: Nephrology Department, The Children`s Hospital and the Institute of Child Health, Lahore from July 1999 to June 2001. Subjects and Methods: Ultrasound guided percutaneous renal biopsy was done in nephrotics, who were (a) steroid resistant (SR), (b) with signs of steroid toxicity (c) deranged renal functions, hypocomplementemia, gross haematuria (d) signs of systemic disease. Patients with congenital nephrosis were not included. The biopsy material was examined under light microscope after staining with H&E and PAS. Results: Thirty-five patients with male to female ratio of 2.5:1 in the age range of 1-1/2 years - 14 years (mean 6.9 years) underwent renal biopsy. Fifteen (42.9%) were SRNS (Steroid resistant nephrotic syndrome), while 7 (20%) had signs of steroid toxicity and deranged renal functions each. Gross haematuria and signs suggestive of systemic disease were present in 3 (8.6%) patients in each group. The most predominant histopathology was mesangioproliferative in 12 (34.2%) followed by MPGN (Membranoproliferative glomerulonephritis) in 7 (20%), MCNS (Minimal change nephrotic syndrome) in 6 (17.1%), membranous nephropathy in 3 (8.85%), FSGS (Focal segmental glomerulosclerosis) and focal proliferative GN (Glomerulonephritis) was seen in 1 (2.85%) each. Among the steroid resistant patients the most common histopathology was mesangioproliferative GN in 7 (46.6%), followed by MCNS and FSGS in 2 (13.2%) each. Overall complication rate was 17.2% in 6 with gross haematuria and flank pain seen in 2 ( 5.7%), while small perirenal haematoma and urinary retention occurred in 1 ( 2.85%) patients in each group. Conclusion: Percutaneous renal biopsy is a safe procedure with minimal risk of complications. It helps the nephrologist to find out the underlying histopathology for the purpose of diagnosis, prognosis and to plan treatment.

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