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A Clinicopathological Study on Re nal Biopsies in Children.

Journal of the Korean Pediatric Society 1986;29(8):868-879.
Published online August 31, 1986.
A Clinicopathological Study on Re nal Biopsies in Children.
Soon Wha Kim, Keun Chan Sohn
Department of Pediatrics,National Medical Center, Seoul, Korea
신생검을 시행한 신질환 환아의 임상 및 병리학적 고찰
김순화, 손근찬
국립의료원 소아과
Abstract
A clinical and histopathologic study was made on 80 cases of renal biopsies in children who were admitted to National Medical Center from January 1976 to June 1985. The results are as follows: 1) Among 80 cases, 60 cases were male and 20 cases female. The sex ratio of male to female was 3 : 1. The age distribution was from 2 years and 2 months to 15 years of age, and the peak incidence occurred at 14 years to 15 years of age in 13 cases. 2) The clinical classification of renal diseases showed nephrotic syndrome 46 cases (57.5%), IgA nephropathy 8 cases(10.0%), Henoch-Schonlein nephritis 7 cases(8.7%), acute glomerulonephritis 7 cases(8.7%) and miscellanous 12 cases. 3) The light microscopic diagnoses of the 53 cases fo rrenal biopsies in children were minimal lesion 33 cases(41.2%), mesangial proliferative glomerulonephritis 12 cases(15.0%), focal and segmental glomerulosclerosis 8 cases(10.0%), diffuse proliferative glomerulonephritis 7 cases(8.8%), membranous nephropathy 7 cases(8.8%), focal segmental glomerulonephritis 5 cases(6.2%), membranoproliferative glomerulonephritis 4 cases(5.0%), chronic sclerosing glomerulonephritis 2 cases(2.5%) and unclassified lesion 2 cases(2.5%). 4) Immunopathologic diagnoses correlated with light microscopic diagnoses of the 57 cases of renal biopsies in children were minimal lesion 20 cases(35.0%), IgA nephropathy 9 cases(15.0%), Henoch-Schonlein purpura 8 cases(14.0%), focal and segmental glomerulosclerosis 6 cases(10.5%), postinfectious glomerulonephritis 4 cases(7.0%), lupus nephritis 3 cases (5.3%), membranoproliferative glomerulonephritis 3 cases(5.3%), membranous glomerulopathy 3 cases(5.3%) and Alport`s syndrome 1 case(1.8%). 5) Histopathologic classification of nephrotic syndrome revealed primary nephrotic syndrome 44 cases(84.7%) and secondary nephrotic syndrome 8 cases(15.3%). The cases of primary nephrotic syndrome were minimal lesion 25 cases(48.1%), focal and segmental glomerulosclerosis 8 ases(15.5%), membranoproliferative glomerulonephritis 3 cases(5.8%), pure diffuse mesangial proliferation 3 cases(5.8%), membranous glomerulopathy 2 cases(3.8%), chronic glomerulonephritis 2 cases(3.8%) and proliferative glomerulonephritis 1 case (1.9%). The cases of secondary nephrotic syndrome were systemic lupus erythematosus 3 cases(5.8%), Henoch-Schdnlein syndrome 2 cases(3.8%), hepatitis B 2 cases(3.S%) and Alport`s syndrome 1 case(l. 9%). 6) Hematuria was observed in 18 cases(34.6%) with nephrotic syndrome and hypertension was observed in 11 cases(21.2%); it occurred in a higher proportion of patients with structural glomerular abnormalities. 7) Massive proteinuria over 2.0 gm per day was observed in 38 cases(73.0%) with nephrotic syndrome and proteinuria over 1.0gm per day in 11 cases(19.2%) and below 1 gm per day in 4 cases(7 7%). 8) Responses to initial steroid theraphy in nephrotic syndrome were no treatment in 18 cases(25%), complete remission in 23 cases(59.0%), partial remission in 10 cases(25.6%) and no response in 6 cases(15.4%). 9) Follow up in nephrotic syndrome after initial steroid therapy were no follow up in 15 cases(28.9%), complete remission 6 cases(ll. 5%), partial remission in 5 cases(9.6%), relapse in 25 cases(48.1%) and dead in 1 case(l. 9%).
Key Words: Renal diseases, Renal biopsy, Nephrotic syndrome.


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