Clinical analysis of renal biopsy in 172 cases with steroid-resistant nephrotic syndrome

Objective To analyze the pathologic constitution, repeated renal biopsy, treatment, prognosis and focal segmental glomerulosclerosis (FSGS) risk factors of children with steroid-resistant nephrotic syndrome (SRNS). Methods A retrospective analysis was made of 172 SRNS cases of renal biopsy in the Pediatric Nephrology Center, the First Affiliated Hospital of Sun Yat-Sen University from September 1, 2006 to August 31, 2016. Results The main pathological types of 172 children with SRNS were FSGS in 72 cases (41.9%), minimal change disease (MCD) in 52 cases (30.2%), and mesangial proliferative glomerulonephritis (MsPGN) in 31 cases (18.0%). There were 11 cases (6.4%) with repeated renal biopsy, 5 cases of 6 children with MCD changed to FSGS; 3 cases of FSGS whose repeated renal biopsy were still FSGS, but the subtype had changed; 2 cases of MsPGN changed to FSGS in repeated renal biopsy.Compared to non-FSGS, the age of onset of FSGS was smaller [3.0(1.7, 6.0) years old vs.5.8(3.4, 8.9) years old], the plasma albumin of FSGS was lower [18.0 (14.0, 22.9) g/L vs.20.0 (15.1, 29.1) g/L], the 24 hours urine protein level was higher [136.0(76.0, 200.0) mg/(kg·d) vs.93.0(55.3, 150.0) mg/(kg·d)], and the differences were all significant(all P 0.05). In 62 cases of FSGS, 25 cases (56.4%) were effective, and 37 cases (84.1%) were effective in 44 cases of MCD, 15 cases (60.0%) were effective in 25 cases of MsPGN, and the diffe-rence of prognosis between different pathological types was statistically significant (P<0.05). Conclusions The most common pathological types of children with SRNS are FSGS, MCD, and MsPGN, but the pathological types can be converted to each other.The smaller the age is, the higher the 24-hour urine protein level is, and the greater the risk of FSGS of the pathological type.When the quantity of 24-hours urine protein was more than 131 mg/(kg·d), it should be alert to the possibility of pathological type of FSGS.In children with MCD, the effective rate of CTX is higher than that of children with FSGS and MsPGN.The prognosis of FSGS is the worst but the prognosis of MCD is better. Key words: Nephrotic syndrome; Steroid-resistance; Renal biopsy; Pathology; Child