Predictive Significance of Renal Histopathology as Correlated with Renal Function in Patients of Nephrotic Syndrome
Keywords:
Nephrotic syndrome, renal biopsy, primary glomerular disease, secondary glomerular disease
Abstract
Background: The advent of renal biopsy in early 1950’s has greatly enhanced the understanding of renal disease including nephrotic syndrome in all areas of clinical nephrology, pathology and investigations. The biopsy data, complemented by appropriate clinical, laboratory information and basic studies has contributed significantly to the body of knowledge of renal disease. Material and methods: This study was undertaken to analyze the usefulness of renal biopsy in patients of nephrotic syndrome. The present study was conducted on 52 patients of nephrotic syndrome, with detailed clinical examinations, relevant biochemical investigations and these patients were subjected to renal biopsy for detailed histopathological examination. Results: Of the 52 cases, 34 (65.4%) were male and 18 (34.6%) were females with male to female ratio of 1.9:1 and mean age being 29.5+ 12.5 years. Pre-biopsy clinical assessment revealed the major cause of nephrotic syndrome as primary glomerular disease in 42 (80.8%). Secondary cause of nephrotic syndrome was suspected in the remaining 10 (19.2%) of patients. After pathological evaluation, the major cause of nephrotic syndrome observed in the present study was primary glomerular diseases which accounted for 40 (76.9 %) patients. Secondary glomerular diseases were observed in the remaining 12 (23.1%) patients. Post biopsy histopathological diagnosis lead to change in therapy in 67.4% of the patients and the alteration of therapy post biopsy most commonly revolved around the use of corticosteroid. In 8 patients therapy with cytotoxic drugs was started. Conclusion: The estimate of prognosis was in agreement (pre-biopsy and post-biopsy) in 61.5 % of cases whereas in 20 (38.5%) patients it was different. In 12 (23.1%) cases a better prognosis was estimated and in 8 (15.4%) cases it was worse than estimated previously.References
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18. Ponticelli C, Mihatsch MJ, Imbasciati E. Renal biopsy: performance and interpretation. In, Davison AM, Cameron JS, Grünfeld JP et al. (eds.). Oxford textbook of clinical nephrology. Second edition. Vol. I. Oxford medical publications. 1998: pp 157-171.
19. Kark RM. Renal biopsy. J Am Med Ass 1968; 205: 220-226.
2. Cohen AH, Nast CC, Adler SG, Kopple JD. Clinical utility of kidney biopsies in the diagnosis and management disease. Am J Nephrology 1989;9:309-315.
3. Manaligod JR, Pirani CL. Renal biopsy in 1885. Semin Nephrol 1985;5:237-239.
4. Silkensen JR, Kasiske BL. Laboratory assessment of kidney disease: Clearance, urinalysis, and kidney biopsy. In, Brenner BM (ed.): Brenner and Rector’s The Kidney. Seventh edn. (Vol. I) Saunders. An imprint of Elsevier. 2004: pp 1107-1150.
5. Cameron JS. The nephrotic syndrome and its complications. Am J Kidney Dis 1987;10:157-171.
6. Gulati S, Sharma AP, Sharma RK, Gupta A, Gupta RK. Do current recommendations for kidney biopsy in nephrotic syndrome need modifications? Pediatr Nephrol 2002; 17(6):404-408.
7. Pesce AJ, First MR. Proteinuria: an integrated review. New York: Marcel Dekker. 1979: pp 131.
8. Adu D et al. The nephrotic syndrome in Ghana: clinical and pathological aspect. Quart J Med 1981;50:297-306.
9. Aggarwal SK, Dash SC. Spectrum of renal diseases in Indian adults. J Assoc Physicians India 2000;48(6):594-600.
10. Vikrant S, Kaushal SK, Sharma A, Parashar BS. Spectrum of renal disease among admitted patients at a tertiary care hospital in Himachal Pradesh. Indian J Nephrol 2004;14:99-195.
11. Paone DB, Meyer LRE: The effect of biopsy on therapy in renal disease. Arch Intern Med 1981;141:1039-1041.
12. Glassock RJ. Proteinuria. In, Massry SG and Glassock RJ (eds.) Massry and Glsssock’s Textbook of Nephrology. 4th ed. Philadelphia: Lippincott William and Wilkins. 2001: pp 555.
13. Falk RJ, Jennette JC, Nachman PH. Primary glomerular disease. In: Brenner B.M. (ed.) Brenner and Rector’s The Kidney, 7th edn. Vol. 2. W.B. Saunders, Philadelphia. 2004; pp 1293-1380.
14. Park MH, D`Agathi V, Appel GB, Pirani CL. Tubulointerstitial disease in lupus nephritis. Relationship to immune deposits, interstitial inflammation, glomerular changes, renal function and prognosis. Nephron 1986;44:309-319.
15. Bohle A, Mackensen-Haen S, Gise H, et al. The consequences of tubulointerstitial; changes for renal function in glomerulopathies. In: Amerio A, Cortelli p, Massry SE (eds.) Tubulointerstitial nephropathies. Boston, Dordrecht, London: Kluwer.1991, pp 29-40.
16. Alpers CE. The Kidney. In Kumar V, Abbas AK and Fausto N (ed.): Robbins and Cotran Pathologic basis of disease. 7th edn. Saunders. An imprint of Elsevier. 2004; pp. 955-1021.
17. Richards NT, Dabry S, Howie AJ, et al. Knowledge of renal histology alters patient management in over 40% of patients. Nephrol Dial Transpl 1994;9:1255-1259.
18. Ponticelli C, Mihatsch MJ, Imbasciati E. Renal biopsy: performance and interpretation. In, Davison AM, Cameron JS, Grünfeld JP et al. (eds.). Oxford textbook of clinical nephrology. Second edition. Vol. I. Oxford medical publications. 1998: pp 157-171.
19. Kark RM. Renal biopsy. J Am Med Ass 1968; 205: 220-226.
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2019-12-28
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