| Evaluation of theIndications of Renal Biopsy in Children with Primary Nephrotic Syndrome |
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Seung Ju Lee |
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Department of Pediatrics, College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea |
| 일차성 신증후군 소아에서 신생검의 적응증에 대한 재평가 |
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이승주 |
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이화여자대학교 의과대학 소아과학교실 |
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| Abstract |
Purpose
: Percutaneous renal biopsy in children with primary nephrotic syndrome(NS)
contributed to establish the renal pathology and clinicopathological correlation. The most common
minimal change lesion(MCL) was steroid sensitive and could be predicted by clinical and
laboratory findings. It was uniformly agreed that most nephrotic children who were predicted as
MCL, should receive an 8 week course of prednisolone before considering renal biopsy. Early
indications of renal biopsy has been those nephrotic children with the age below 1 year and
above 8 years, hypertension, hematuria, low serum C3, renal insufficiency which are not
compatible with MCL. Late indications has been frequent relapser(FR), steroid dependent(SDNS)
and steroid resistant nephrotic syndrome(SRNS). The indications have been challenging recently
and we tried to evaluate the commonly recommended indications.
Methods
: Clinical, laboratory, pathologic findings and therapeutic responses were compared in
81 children with primary nephrotic syndrome who had renal biopses beteen 1984 and 1996.
Results
:
1) Among 11 children with the age indication, MCLs were diagosed in 9(81.8%), mesangial
proliferative glomerulonephritis(MsPGN) in 1(9.1%) and membranous nephropathy(MGN) in
1(9.1%).
2) Among 4 children with microscopic hematuria, MCLs were diagosed in 3(75.0%), MsPGN
in 1(25.01%). In 13 children with hypertension, macrohematuria, azotemia and low serum C3,
focal segmental glomerulosclerosis(FSGS), membrano-proliferative glomerulonephritis(MPGN) and
IgA nephropathy(IgA) were frequently diagnosed instead of MCL.
3) All 5(100%) frequent relapsers were diagnosed as MCLS Among 30 children with the
indication of SDNS, MCLs were diagosed in 28(93.3%), MsPGN in 2(6.7%)
4) Among 18 children with the indication of SRNS, MCLs were diagosed in 6(33.3%),
MsPGN in 6(33.3%), FSGS in 6(33.3%)
5) The probability to diagnose MCL was 81.8%(9/11) in age indication, 75.0%(3/4) in
microscopic hematuria, 100%(5/5) in FR and 93.3%(28/30) in SDNS.
6) The response rate to standard steroid treatment were 81.8%(9/11) in age indication
75.0%(3/4) in microscopic hematuria, 100%(5/5) in FR and 96.7%(29/30) in SDNS.
Conclusion
: Among the commmon indications of renal biopsy in children with primary
nephrotic syndrome, age, microscopic hematuria, frequent relapser and steroid dependant should
be reevauated to reduce the unnecessary renal biopsy. |
| Key Words:
Age, Microscopic hematuria, Frequent relapser, Steroid dependent |
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