Histopthological spectrum of renal biopsies in pediatric population: an update

To determine the histological spectrum and indications of renal biopsies in pediatric population from birth to 16 year of age and to delineate any change in histological pattern with time and age at tertiary care hospital in Karachi. Cross sectional study. This study was carried out at Aga khan University Hospital Karachi over a period of 7.5 years from January 2006 to July 2014. A retrospective review of the computerized database of the histopathology department of Aga khan University hospital [AKUH] was carried out on children from birth to 16 years of age who underwent renal biopsy. All renal biopsy specimens were processed, cut and stained and evaluated under light microscopy and immune fluorescence technique. The indication and findings of these biopsies and demographic data such as age and sex were identified. Frequencies and percentages were used for categorical variables and mean +/- standard deviation for quantitative variables. SPSS version 19.0 for statistical analysis. Mean age was 11.5 years +/- 3.5years with an age range from 3 months to 16 years with majority of the patients over 10 years of age. Out of 128 patients 79[61.7%] were male and 49[38.3%] were female with a ratio of 1.6: 1.The most common indication observed for renal biopsy was Nephrotic syndrome seen in 75[58.6%] cases with 36 [28.1%] being steroid resistant variety followed by steroid sensitive 25 [19.5%]. Other indications observed were Nephritic syndrome 16 [12.5%], renal failure 13[10.2%] and lupus nephritis for classification 11[8.6%]. The most frequent renal disease observed was focal segmental glomerulosclerosis [FSGS] 38[29.7%]. Others being minimal change disease 19[14.8%], membranous glomerulonephritis 12 [9.4%]. The most frequent biopsyfinding in all age group was FSGS. The distribution of renal diseases in pediatric age group described is similar to that described in national and international literature with some differencesobserved.This study provides updated epidemiological information on childhood renal diseases

Frequency of non-diabetic renal disease [NDRD] in type II diabetes mellitus

To describe the frequency of NDRD in type II diabetic patients who underwent renal biopsy for deranged renal functions that includes haematuria, proteinuria in the nephrotic and non-nephrotic range and rapidly worsening renal failure. A descriptive study was undertaken in the Department of histopathology at The Kidney Postgraduate Center, Karachi, Pakistan from January 2000 to May 2005. The renal biopsies of 73 patients of type II diabetes were evaluated when a renal disease other than diabetic glomerulosclerosis [DGS] was suspected because of unexplained haematuria, clinically significant proteinuria in nephrotic and non-nephrotic range and rapidly progressive renal failure or unexplained renal failure with normal sized kidney. Three groups of patients were defined on the basis of renal damage noted on light microscopy and immunoflourescence investigations. Group I was NDRD alone, group II NDRD with co-existent DGS and group III DGS alone. The relationship of histology with clinical profile in each group and duration of diabetes were noted and analyzed using SPSS 15 software. Of the 73 patients studied 46 were males and 27 were females [1.7:1]. Group I and II tended to have a younger age group at presentation [49.26 +/- 9.37 years and 49.0 +/- 5.72 years respectively] than group III [53.62 +/- 6.62 years]. The mean duration of diabetes was 9.9 +/- 10.42 years in group I, 7.5 +/- 3.78 years in group II and 13.31 +/- 1.71 years in group III. Among patients 30 [41.1%] had NDRD alone, 06 [8.21%] had NDRD co-existent with DGS, and 37 [50.7%] had DGS alone. Focal segmental glomerlosclerosis [FSGS] and tubulointerstitial nephritis [TIN] were the most common lesion and accounted for 22.2% and19.4% respectively. Amount of proteinuria was higher in patients of NDRD [3.064 +/- 1.38 gms/24 hrs in group I and 3.316 +/- 0.97 gms/24 hrs in group II] than those of DGS [2.815 +/- 0.916 gms/24 hrs] but it did not reach statistical significance. Serum creatinine was significantly raised in patients of group III [3.391 +/- 0.927 mg/dl] versus group I [2.563 +/- 0.95 mg/dl] and II [2.633 +/- 0.952 mg/dl] [p 0.002]. The presence of haematuria was seen in greater number in patients of NDRD [32.5% in group I and 33.3% in group II] versus DGS [in group III 29.6%], but it did not reach statistically significant values. This study shows a high frequency of NDRD in type II diabetic patients who underwent a renal biopsy for impaired renal functions emphasizing the significance of biopsy in such patients in order to tailor their management accordingly

evaluation of renal biopsy in type-II diabetic patients

To determine the renal damage in type-II diabetic patients, who underwent renal biopsy for impaired renal functions and its role in overall patient management. Descriptive, cross-sectional study. The Kidney Postgraduate Centre, Karachi, Pakistan from January 2000 to May 2005. Histopathological evaluation of 73 patients of type-II Diabetes mellitus were included who underwent renal biopsy. Renal biopsy was performed when a renal disease other than diabetic nephropathy was suspected because of the presence of haematuria, nephrotic syndrome, non-nephrotic proteinuria < 3 gms/day in the absence of retinopathy, rapidly progressive glomerulonephritis and renal insufficiency of unknown origin. On the basis of light microscopy and immunofluorescence, three groups of patients were defined. Group I was characterized by diabetic glomerulosclerosis [DGS] only, group II by the prevalence of vascular changes, while group III had sub-groups IIIa [DGS co-existing with nondiabetic renal diseases] and IIIb [non-diabetic renal diseases without DGS]. Among the 73 patients studied, 20 [27.3%] had diabetic glomerulosclerosis alone [group I], 17 [23.3%] showed occurrence of vascular changes [group II], and 36 [49.3%] had non-diabetic renal diseases [group III]. Mean serum creatinine level was significantly greater in group II than in group I and III [p < 0.001]. Amount of proteinuria and the presence of haematuria did not show a statistically significant difference in groups I, II and III. The systolic and diastolic blood pressure was higher in groups II as compared to group I and III [p < 0.001]. The percentage of sclerotic glomeruli, tubular injury and interstitial inflammation in group II were significantly greater than group I and III [p < 0.001]. Type-II diabetic patients undergoing renal biopsy for impaired renal functions constituted a heterogeneous group of renal damage. This study emphasized the usefulness of renal biopsy for determining the pattern of renal damage that would aid in the overall management of the patients