All issues > Volume 34(6); 1991

Original Article

J Korean Pediatr Soc. 1991;34(6):805-811. Published online June 30, 1991.

Re-evaluation of the indication for renal biopsy in childhood nephrotic syndrome.

Eun Kyoung Sohn¹, Byung Soo Cho¹, Chang Il Ahn¹

¹Department of Pediatrics, College of Medicine, Kyung Hee University, Seoul, Korea

Received: August 2, 1990;  Accepted: October 5, 1990.

Abstract

Renal biopsy is indicated in nephrotic syndrome when histopathologic types other than minimal change pattern or the secondary nephrotic syndrome are suspected. But renal biopsy in children has some limitation because of the technical problem. In order to assess the clinicopathologic correlation and to re-evaluate the biopsy indication, the clinical manifestations and histopathologic types were analyzed statisically on the 86 cases of childhood nephrotic syndrome which were admitted from Jan. 1980 to July 1989 at the dept, of pediatrics in Kyung Hee University Hospital. Diagnosis was established on the tissue specimens by renal biopsy under the ultrasound guide, by light, fluorescent and electron microscopic examination. The biopsy indications were as follows: 1) age: less than 1 year or more than 7 years old 2) microscopic or gross hematuria 3) freqent relapse 4) HBsAg positive 5) hypertension 6) steroid resistant 7) family history The results were as follows: 1) The age distribution was 6 months old to 20 years old and male to female ratio was 3.8:1 2) Minimal change nephrotic syndrome was the most common histopathologic result of biopsy, 58 cases (67%). The other histopathologic finding were FSGS (11 cases), MPGN (4 cases), MGN (4 cases), MesPGN (3 cases), IgA nephropathy (3 cases), PSGN (2 cases), and congenital nephrotic syndrome (1 case). 3) Among the histopathologic result of MCNS, the proportion of biopsy cases done with the age indication was 42.9%, and among the other histopathologic result, it was 17.4% (p>0.05). 4) Among the biopsy result of MCNS, the proportions of the cases done with the other indications described above except age were not higher significantly than the proportion of the cases done with the same indications respectively among the other histopathologic types (FSGS, MPGN, MGN, MesPGN, IgA nephropathy, PSGN, congenital nephrotic syndrome). In conclusion, renal biopsy is considered before any treatments in cases of early onset type (less than 1 year) because this type is likely to be congenital nephrotic syndrome which is poor in prognosis, and in the cases of other biopsy indications (hematuria, frequent relapser positive HBsAg, hyperten- sion, steroid resistant, family history). But it would not be harmful to try steroid treatment before renal biopsy when the onset of nephrotic syndrome is late (over 7 years old).

Keywords :Childhood nephrotic syndrome;Indication for renal biopsy