Abstract

CHANGING SPECTRUM OF NEPHROTIC SYNDROME: A CLINICOPATHOLOGY STUDY

Dr. Archana Joshi*, Dr. Leena Gajare and Dr. Sadhana Mahore

Abstract

The nephrotic syndrome (NS) is a clinical syndrome complex characterized by number of renal and extra renal features and is defined by a urinary protein level exceeding 3.5 gm per 1.73 m2 of body-surface area per day. The aim was to study clinical profile, the histopathological spectrum of renal biopsies in NS and to correlate histopathological spectrum with clinical profile. Material and methods: Total 120 patients of all age groups diagnosed clinically with NS and subjected to renal biopsy were included in study while those with insufficient biopsy material were excluded from our study. Results: In the present study patient’s age ranged from 6 to 79 years with the mean age of 36.73 + 15.81 years. Male: Female ratio was 2:1. Overall most common etiology of NS was Minimal change disease (MCD) and in pediatric age group was Focal and segmental glomerulosclerosis (FSGS). Most common cause of primary NS was MCD while Diabetic nephropathy (DN) was most common cause of secondary NS. Most common clinical presentation was pedal edema. Elevated serum creatinine was observed in 21 patients. Hypercholesterolemia was detected in 89 patients. Microscopic hematuria was present in 47 patients. The most common complication in our NS study was urinary tract infection (UTI) followed by acute kidney injury (AKI), chronic kidney disease (CKD), pneumonia and thrombosis. All patients had hypoalbuminemia. All patients were seronegative for HIV, HBsAg and HCV. All 6 patients with LN had ANA and dsDNA positive. Conclusion: MCD is the most common cause of NS in adults while FSGS in pediatric age group. In view of changing histological spectrum of NS it is essential to maintain a national renal biopsy registry data which would help to obtain accurate knowledge of spectrum, presentation, incidence and complications.

Keywords: Nephrotic syndrome, renal biopsy, spectrum of renal disease.