Epidemiology of 10-year paediatric renal biopsies in the region of southern Croatia

Abstract

Background: Information about renal diseases in children is available from national registries of renal biopsies. Aim of the study was to compare the clinical presentation of glomerular diseases and tubulointerstitial space diseases with pathohistological diagnosis of indicated renal biopsies from pediatric population in the Croatian region of Dalmatia.

Methods: Out of 231 pediatric patients with suspected glomerular and tubulointerstitial diseases, 54 underwent ultrasound-guided renal biopsy at University Hospital of Split. Kidney allograft biopsy, and re-biopsy were excluded. The biopsy sections were examined under light microscopy, immunofluorescence and electron microscopy. The data was reviewed to determine the pathohistological spectrum and clinicopathologic correlations. We retrospectively analyzed kidney biopsy data from 2008 to 2017 and compared them to that between 1995 and 2005.

Results: The mean age of patients was 9.84 ± 5.4 years. Male:female ratio was 1.2:1. The main indications for biopsy were pure nephrotic syndrome without hematuria (25.9%), non-nephrotic proteinuria with haematuria (22.2%), nephritic syndrome with nephrotic proteinuria (18.5%), and isolated hematuria (16.7%). The most common pathohistological findings were IgA nephropathy (IgAN, 24.1%), minimal change disease (MCD, 16.7%), Henoch-Schönlein purpura glomerulonephritis (HSPN, 14.8%), Alport syndrome and focal segmental glomerulosclerosis (AS and FSGS, 11.1% each), tubulointerstitial nephritis and membranous glomerulopathy (TIN and MGN, 3.7% each), while other cases were diagnosed rarely.

Conclusions: Changes in epidemiology of renal diseases in children between the analyzed periods showed an increasing trend of IgAN, MCD, HSPN, AS and FSGS, while mesangioproliferative glomerulonephritis (MesPGN) and endoproliferative glomerulonephritis (EDGN) showed a decreasing trend that can be explained with the new pathohistological classification.

Keywords: Epidemiology; Nephrotic syndrome; Registries; Renal biopsy.

Fig. 1

Number of total hospitalized renal patients which presented with glomerular or tubulointerstitial disease and renal biopsies for each year

Fig. 2

a Frequency of pathohistologic diagnoses in children with non-nephrotic proteinuria with haematuria (12 renal biopsies). b Changes seen in the epidemiology of renal disease in children between the periods 1995–2005 and 2008–2017. C3GN (C3 glomerulonephritis), Mesangioproliferative glomerulonephritis (MesPGN), IgA nephropathy (IgAN), Henoch-Schӧnlein purpura nephritis (HSPN), Tubulointerstitial nephritis (TIN), Focal segmental glomerulosclerosis (FSGS), Endoproliferative glomerulonephritis (EDGN), Alport syndrome (AS), Minimal change disease (MCD), Crescentic glomerulonephritis (Crescentic GN), Membranous glomerulopathy (MGN), Lupus nephritis (LN), C1q nephropathy (C1qN), Focal segmental necrotizing glomerulonephritis (FSNGN), C3 glomerulopathy (C3G), Thin basement membrane nephropathy (TBMN), Fibrillary glomerulonephritis (FG), Renal vasculitis (RV), Membranoproliferative glomerulonephritis (MPGN), Nephronophthisis, Diffuse mesangial sclerosis (DMS); *p < 0.05, 1995–2005 vs, 2008–2017

Fig. 3

22-year long timeseries of relative frequencies with optimal jointpoint regression models for each pathologic entity. Mesangioproliferative glomerulonephritis (MesPGN), IgA nephropathy (IgAN), Henoch-Schӧnlein purpura nephritis (HSPN), Tubulointerstitial nephritis (TIN), Focal segmental glomerulosclerosis (FSGS), Endoproliferative glomerulonephritis (EDGN), Alport syndrome (AS), Minimal change disease (MCD)