Histopathological pattern of pediatric renal disease-our experience at Kamineni Hospitals, Hyderabad

Introduction: Renal biopsies are very important in diagnosing and managing children with renal diseases. There are few studies which highlight the histological pattern of renal diseases in pediatric age group. Objective: This study was conducted to analyse indications for renal biopsies, and also histological pattern of renal diseases in children which were referred to the Pathology department, Kamineni Hospitals, Hyderabad by the Nephrology department, Government General Hospital, Kurnool. Materials and Method: A retrospective analysis of kidney biopsy reports from December 2013 to December 2016 was done. Adult biopsies, inadequate and renal allograft biopsies were excluded from the study. Only pediatric age group of 1-14 years was considered. Results: Out of total 750 biopsies, 130 cases belong to pediatric age group. Male to female ratio is 1.8:1, with a mean age of 10 + of -4. Nephrotic syndrome is the most common indication for renal biopsies and histologically minimal change disease (MCD) is the most common (43%) histological pattern followed by membranoproliferative glomerulonephritis (MPGN) (18%), focal segmental glomerulosclerosis (FSGS) (11%), and Post infectious glomerulonephritis PIGN (10%) etc. Conclusion: Nephrotic syndrome is the most common indication for renal biopsies and MCD is the most common type of glomerulonephritis among pediatric cases diagnosed at our institution. Introduction Renal biopsies are very important in diagnosing and managing children with renal diseases. Indications for renal biopsies vary from center to center. The common clinical indications for renal biopsy include nephrotic syndrome (NS), prolonged acute renal failure (ARF), rapidly progressive renal failure (RPRF), systemic disease with renal dysfunction, non-nephrotic proteinuria, isolated microscopic hematuria, unexplained renal failure, renal transplant dysfunction, and familial renal disease. Renal biopsy is less frequently performed in children compared to adults. This difference is due to the fact that the nephrotic syndrome in children is assumed to have minimal change disease (MCD), and steroid therapy is given without going for biopsy as it is invasive and painful. Now with the availability of automated triggered biopsy gun, and real time ultra sound, kidney biopsy is a safe procedure that can be easily performed. There are several published reports on pediatric kidney biopsies from different countries. In India, very few reports have been published giving insight into epidemiological data and the spectrum of clinically significant renal disease. Immune mechanisms are responsible for glomerular injury in majority of cases of primary glomerulonephritis (GN), and many of the secondary GN. Correct diagnosis of glomerulonephritis requires renal biopsy and histopathological examination by light microscopy, immunofluorescence and electron microscopic examination. Facilities for electron microscopic studies are not easily available in India. In most cases, light microscopy (LM) and direct immunofluorescence (DIF) studies are adequate for definite diagnosis of GN. Patients with immune deposits can be treated easily with steroids or immunosuppressants. We conducted this study to analyse indications for renal biopsies and their histological pattern in pediatric cases. Materials and Method A retrospective analysis of kidney biopsy reports from December 2013 to December 2016 was done. All biopsies were done at Government General Hospital, Kurnool, Andhra Pradesh, and were transported to Kamineni Hospitals, Hyderabad in Michels Media for DIF, and in formalin for LM. The age group considered was 1-14 years. Renal biopsies of adult patients, inadequate and renal allograft biopsies were excluded from the study. Minimum workup of the patients included clinical presentation (Nephritic/Nephrotic/End stage disease/others), size of the kidneys, blood pressure, blood urea, serum creatinine, and urine analysis giving albumin and sugar levels and microscopy, including red blood cells, white blood cells per high power field and casts. All biopsies were performed by a well experienced nephrologist using an automatic triggered biopsy gun. Histopathological evaluation of the biopsy specimens was done by LM and DIF. Electron microscopy was not available. In Light Microscopy, biopsies were stained routinely with Hematoxylin and Eosin (Fig. 1a, 1b, & 1c), Periodic acid schiff stain (Fig. 1d), Masson Trichrome stain, and Silver methenamine. Direct E. Jayashankar et al. Histopathological pattern of pediatric renal disease – our experience at Kamineni. Indian Journal of Pathology and Oncology, October-December 2017;4(4):575-579 576 Immunoflourescence staining was done with antibodies against Immunoglobulins A, G, M, and C3c, and C1q. All specimens were reviewed by two qualified pathologists. The data were stored in Microsoft excel and statistics like percentage, and mean were calculated. Results A total of 750 renal biopsies were analysed, out of which 130 cases belonged to pediatric age group. Male to female ratio was 1.8:1, with a mean age of 10 + 4. The most common indication for renal biopsy was nephrotic syndrome: 100 (77%) followed by nephritic syndrome: 14 (10.7%), Rapidly progressive renal failure (RPRF): 6(4.6%), Lupus nephritis: 8(6.4%), and Acute glomerulonephritis (AGN): 2(1.5%) [Table 1] Table 1: Pattern of Clinical Indications for Renal biopsies in Children Clinical Indication for Biopsy Numbers (%) Nephrotic Syndrome(NS) ? MCD/FSGS/MGN/MPGN 80 (61.5) Steroid Dependent NS 18 (13.8) Steroid Resistant NS 02 (01.5)