Role of Renal Biopsy in Children with Steroid Dependent and Steroid Resistant Nephrotic Syndrome

Objective: To determine the role of renal biopsy in children with steroid dependent and steroid resistant nephrotic syndrome in terms of histological type Methodology: This was a cross sectional study conducted at the Department of Paediatric Medicine, Children Hospital, PIMS, Islamabad from January 2013 to June 2013. A total of 20 children aged 1 to 12 years with steroid dependent or steroid resistant nephrotic syndrome underwent renal biopsy using Spring cut renal biopsy needle under ultrasound guidance and general anesthesia. Two samples were taken and sent for light microscopic examination and immunoflouresence. SPSS version 11.0 was used for data analysis. Mean and standard deviations were calculated for numerical variables like age, duration of NS, Hb, blood urea, serum creatinine, C3 and C4 levels. Frequency and percentages were calculated for categorical variables like sex, ultrasound findings and biopsy findings. Results: The three predominant lesions on histopathology were minimal change disease (MCD) 25.0%, IgM mesangioproliferative glomerulonephritis (IgMN) 25.0% and focal segmental glomerulosclerosis(FSGS) 20.0%. Less common lesions include membranoproliferative glomerulonephritis 15.0%, IgA nephropathy 15.0%, membranous nephropathy 5.0% and post infectious glomerulonephritis 5.0%. Conclusion: MCD, IgMN and FSGS are the predominant lesions in children with steroid dependent nephrotic syndrome and steroid resistant nephrotic syndrome. Renal biopsy provides important information on renal histopathology, prediction of prognosis and therapy in children with SDNS and SRNS.