Clinicopathological study of nephrotic syndrome in Indian children :A tertiary care experience

  • Chetan Sudhakar Chaudhari Assistant Professor,Dept of Pathology LTMMC & LTMGH,Sion,Mumbai
  • Nitin M Gadgil
  • Prashant V Kumavat
  • Ganesh R Kshirsagar
  • Sagar Dhamne
Keywords: Paediatric, Nephrotic Syndrome, Electron Microscopy, Immunofluoresence


Background: Nephrotic syndrome is an important chronic disorder in children with clinical manifestation of different histopathological subtypes. An aim of the study was to determine incidence of renal biopsy in paediatric nephrotic syndrome, correlations between the clinical and histomorphological patterns in Indian ethnicity children at our tertiary care institute.Methods: : A retrospective study of kidney biopsies with, immunofluorescence and electron microscopy with clinical outcome of the children with nephrotic syndrome was done over a period of 15 years. Biopsies were stained with Hematoxylin & eosin, Periodic acid Schiff and silver impregnation stain and also processed for immunofluorescence and electron microscopy as necessary. All renal biopsy findings were correlated with clinical response to steroid therapy, immunosuppressant, and clinical parameters.Result: Frequencies in results were calculated by Chi square test for categorical variables. Mann-Whitney U test was used for non parametric variables. Predominantly cases were seen in the age group 8-12 years. Atypical nephrotic syndrome was the commonest presenting feature followed by steroid resistant nephrotic syndrome. Minimal change disease was the commonest histomorphological pattern followed by focal segmental glomerular sclerosis. All the cases of membranous glomerulonephritis in study were secondary in nature. Light microscopy findings correlated with electron microscopy, in 80.95% cases.Conclusion: Minimal change disease occurs up to 6 times more commonly in Indian children than in Europian counterpart, but rise in FSGS cases as a cause for nephrotic syndrome is now being encountered. In India the proportion of cases with Membrano-proliferative glomerulonephritis is high, attributable to the high prevalence of infectious diseases like tuberculosis, chronic suppurative infections and malnutrition. DOI: 10.21276/apalm.2017.995


1. Abramowicz M, Barnett HL, Edelmann Jr. CM, et al. Controlled trial of Azithioprine in children with nephrotic syndrome: A report for International Kidney Diseases in Children. Lancet.1970; (i) 7654: 959-961.
2. Sanjeev G, Debashish S, Sharma RK, et al. Steroid resistant nephrotic syndrome: role of histopathology. India Paediatrics.2006; 43:55- 60.
3. Mallick NP. Epidemiology and natural course of idiopathic nephrotic syndrome. Clin Nephrol.1991; 35: S3-S7.
4. Souilmi FZ, Houssaini TS, Alaoui H, et al. Indications and results of renal biopsy in children: A single-center experience from Morocco. Saudi J Kidney Dis Transpl. 2015; Jul-Aug;26(4):810-15.
5. Kumar J, Gulati S, Sharma AP, Sharma RK, Gupta RK. Histopathologic spectrum of childhood nephrotic syndrome in Indian children. Pediatr Nephrol.2003; 18:657-660.
6. Habib R, Kleinknecht C. The primary nephrotic syndrome in childhood: classification and clinicopathologic study of 406 cases. Sommers SC, ed. Pathology annual. 1971;417-474
7. White RHR, Glasgow EF, Mill RJ. Clinicopathological study of nephrotic syndrome in childhood. The Lancet.1970; i(7661):1353-1359.
8. Cho BS, Yoon SR, Jang JY, Pyun KH, Lee CH. Up-regulation of interleukin-4 and CD23/FcepsilonRII in minimal change nephrotic syndrome. Pediatr Nephrol.1999; 13: 199-204.

9. Yap HK, Cheung W, Murugasu B, Sim SK, Seah CC, Jordan SC.Th1 and Th2 cytokine mRNA profiles in childhood nephrotic syndrome: Evidence of increased IL-13 mRNA expression in relapse. J Am Soc Nephrol.1999; 10: 529-537.
10. Van Der Berg JG, aten J, Annink C, Ravesloot JH, Weber E, Weening JJ. IL-4 and IL-13 promote basolateral secretion of H(+) and cathepsin L by glomerular epithelial cells. Am J Physiol Renal Physiol.2002; 282: F26-F33.
11. Southwest Pediatric Nephrology Study Group. Childhood nephrotic syndrome

associated with diffuse mesangial hypercellularity. Kidney Int1983; 24: 87–94

12. Bonilla-Felix M, Parra C, Ferris M, et al. Changing patterns in the histopathology of idiopathic nephrotic syndrome. Kidney Int.1999; 55:1885-1890.
13. Waldherr R, Gubler MC, Levy M, Broyer M, Habib R. The significance of pure mesangial proliferation in idiopathic nephrotic syndrome. Clin Nephrol.1978; 10:171-179.
14. Bernstein J Jr, Edelmann CM Jr. Minimal change nephrotic syndrome: histopathology and steroid responsiveness. Arch Dis Child.1982; 57: 816.
15. Hirszel P, Yamase HT, Carney WR, et al. Mesangial proliferative glomerulonephritis with IgM deposists: clinicopathologic analysis and evidence for morphologic transitions. Nephron.1984; 38:100-108.
16. Berger J, Hinglais N. Intercapillary deposits of IgA-IgG. J Urol Nephrol (Paris).1968;74(9):694-5

17. Sagel I, Treser G, Ty A, et al. Occurrence and nature of glomerular lesions after group A streptococci infections in children. Ann Intern Med. 1973;79:492–499.

18. Jennette JC, Olson MD, Silva MD. Heptinstall’s Pathology of the Kidney. 7th ed. Philadelphia: Wolters Kluwer; 2014.
Original Article