Spectrum of Biopsy Proven Renal Diseases in the Paediatric Age Group between 1997-2006 from a Tertiary Center of India.

BACKGROUND : The incidence of renal diseases among paediatric age group is not uncommon and nephrotic syndrome is considered as the most common clinical and histopathological diagnosis among all types of renal diseases in children. However, there is a limited data on the distribution of various histopathological spectrum of biopsy proven renal diseases in the paediatric population from developing countries. PATIENTS AND METHODS : A retrospective as well as prospective study was performed from January 1997 to December 2006 at our center involving 1480 children ( age 1 month to 18 years) who have undergone renal biopsy. The data was complete in 887 patients and this was analyzed. AIM AND OBJECTIVES : 1. To study the distribution of various renal diseases in pediatric age group in our center 2. To analyze patient characteristics, clinical and biochemical parameters among each group of biopsy proven renal diseases. 3. To study the various modality of treatment and its out come among these patients. RESULTS : The study included 887 children for whom biopsy reports were available. There were 554 males and 333 females. The distribution of various diseases were as follows: Minimal change disease in 303 (34.16%), Mesangial proliferative GN in 146 (16.45%), Lupus nephritis in 98(11.05%), Proliferative glomerulonephritis in 81(9.13%), IgA nephropathy in 61 (6.87%), Focal segmental glomerulosclerosis in 59(6.65%), Diffuse mesangial hypercellularity in 53(5.97%), Membranous glomerulonephropathy in 24(2.70%), Crescentic glomerulonephritis in 15(1.69%), Membrano proliferative glomerulonephritis in 8(0.9 %),Hemolytic uremic syndrome in 5 (0.56 %),Vasculitis in 3(0.33 %), acute interstitial nephritis in 3 (0.33 %),acute tubular necrosis in 2(0.22 %), granulomatous interstitial nephritis in 3(0.33%), end stage etiology of unknown etiology in 17(1.92 %) and inadequate sample in 2 (0.22%) children. Mean age at onset of MCD was 8.48 ± 4.7, 1-18 yrs years. In our patients, haematuria was seen in 9 % patients with MCD, 12.8 % patients with FSGS and 28.6% patients with MPGN. Hypertension was seen in 7% patients with MCD, 21.1%patients with FSGS and 12.1 % patients with MPGN. CONCLUSION : In children under 8 years of age, minimal change disease was the most common entity, whereas Focal segmental glomerulosclerosis predominated in children with age at onset greater than 8 years. The age at onset of nephrotic syndrome was significantly higher in the non-MCD group than the MCD group. The incidence of hypertension, microhematuria, gross hematuria and was significantly lower in the MCD group. MCD remains the most common histopathological subtype in Indian children with idiopathic nephrotic syndrome and the incidence of Membranoproliferative glomerulonephritis has been found to have declined. The incidence of lupus nephritis has increased. This study provides descriptive epidemiological biopsy data and highlights some important trends in changing prevalence of renal disease.