Histopathologic variants of minimal change nephrotic syndrome among Egyptian children: clinical significance and long-term evolution

ABSTRACT

It is widely accepted that minimal change nephrotic syndrome [MCNS] is the most common cause of nephrosis in children. Minimal change disease typically shows no abnormalities in light microscopy. However, there are some minor light microscopic abnormalities that are considered to be MCNS variants. The aim of this study was to investigate the clinical importance and long-term outcomes of some minimal change variants. This retrospective study included 124 children with idiopathic MCNS, diagnosed between 1998 and 2001 at the Urology and Nephrology Center, Mansoura University. Their clinical records, follow up data and renal samples were reviewed. Among them 76 were males and 48 were females, and their age ranged from 2 to 12 years [median 4.2 years]. They were classified into three subgroups nil disease [62 patients], mild mesangial hypercellularity [MMH] [38 patients], and mild mesangial thickening [MMT] [24 patients]. Patients with MMH had significantly higher age at onset and significantly higher number of relapses prior to biopsy compared to the nil disease group [p 0.02 and p 0.09, respectively]. Patients with MMH had significantly higher serum creatinine, and significantly lower creatinine clearance than those with MMT [p=0.011 for both]. There was no significant difference between the groups as regards the incidence of permanent remission, steroid dependence, steroid resistance, infrequent relapses or frequent relapses over the four years after renal biopsy. Serial creatinine clearance done yearly for four years showed insignificant differences among the three groups. Mild mesangial hypercellualrity may differ initially from other minimal change variants as regard age of onset frequency of relapses, and renal function, but follow-up for 4 years revealed insignificant differences between these groups clearance