Department of Pathology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital; Department of Pathology, Tata Memorial Hospital, A CI of Homi Bhabha National Institute, Mumbai, Maharashtra, India.
Department of Pathology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India.
Saudi J Kidney Dis Transpl. 2021 Nov-Dec;32(6):1744-1753. doi: 10.4103/1319-2442.352437.
Pediatric renal biopsy is an uncommon event, and the spectrum of the disease is evaluated and managed mostly on the clinical grounds. Compared to adults, the indications for renal biopsy in pediatric population are very few. We reviewed the pediatric renal biopsies received at our tertiary center in Mumbai, India, over a period of six years to study the incidence of various medical renal diseases, their spectrum on histology and its correlation with electron microscopy (EM). A total of 65 pediatric renal biopsies in the age group of 0-12 years were evaluated over a period of six years. The mean age of our patients was 7.9 years, with a median of 8.8 years with a male-to-female ratio of 1.3:1. The overall most common indication for biopsy was nephrotic syndrome (NS) including steroid-resistant NS, followed by proteinuria and nephritic syndrome. Majority of the lesions included in the study were primary glomerular disease (71%) while secondary glomerular disease amounted to 18%. The spectrum of disease includes minimal-change disease (MCD) (27.7%), followed by membranoproliferative glomerulonephritis (MPGN) (15.38%), focal segmental glomerulosclerosis (FSGS) (9.23%), lupus nephritis (7.7%), hemolytic uremic syndrome (7.7%), MPGN (6.15%), advanced renal disease (6.15%), membranous glomerulonephritis (3.07%), and crescentic glomerulonephritis (3.07%). This study is an important contribution to the epidemiology of pediatric renal disease spectrum in the Indian population. We conclude that MCD is the most common pathology seen in pediatric age group, with NS as the most common indication for biopsy. There is a steady increase in the incidence of FSGS in the pediatric population with frequent relapses and an increase in the incidence of steroid resistance. However, with the use of immunofluorescence and EM, an accurate diagnosis is possible, so an early renal biopsy should be planned in nonresponding cases and at times even before starting the treatment for appropriate treatment.
儿科肾活检是一种不常见的情况，疾病的谱主要是基于临床依据进行评估和管理。与成人相比，儿科人群进行肾活检的指征非常少。我们回顾了在印度孟买的三级中心接受的儿科肾活检，以研究各种医学肾脏疾病的发病率、组织学表现及其与电子显微镜（EM）的相关性。在六年的时间里，我们评估了 65 例年龄在 0-12 岁之间的儿科肾活检。我们患者的平均年龄为 7.9 岁，中位数为 8.8 岁，男女比例为 1.3:1。活检的总体最常见指征是肾病综合征（NS），包括激素耐药性 NS，其次是蛋白尿和肾炎综合征。研究中包括的大多数病变是原发性肾小球疾病（71%），而继发性肾小球疾病占 18%。疾病谱包括微小病变病（MCD）（27.7%），其次是膜增生性肾小球肾炎（MPGN）（15.38%）、局灶节段性肾小球硬化症（FSGS）（9.23%）、狼疮性肾炎（7.7%）、溶血尿毒综合征（7.7%）、MPGN（6.15%）、晚期肾病（6.15%）、膜性肾小球肾炎（3.07%）和新月体性肾小球肾炎（3.07%）。这项研究是对印度人群儿科肾脏疾病谱流行病学的重要贡献。我们得出结论，MCD 是儿科年龄组最常见的病理学表现，NS 是活检的最常见指征。FSGS 在儿科人群中的发病率稳步上升，且频繁复发，激素耐药性增加。然而，通过免疫荧光和 EM 的应用，可以做出准确的诊断，因此在非反应性病例中甚至在开始治疗之前，都应该计划进行早期肾活检，以进行适当的治疗。
