Epidemiology of Pediatric Renal Diseases and its Histopathological Spectrum - A Single-Center Experience from India

Abstract

Pediatric renal biopsy is an uncommon event, and the spectrum of the disease is evaluated and managed mostly on the clinical grounds. Compared to adults, the indications for renal biopsy in pediatric population are very few. We reviewed the pediatric renal biopsies received at our tertiary center in Mumbai, India, over a period of six years to study the incidence of various medical renal diseases, their spectrum on histology and its correlation with electron microscopy (EM). A total of 65 pediatric renal biopsies in the age group of 0-12 years were evaluated over a period of six years. The mean age of our patients was 7.9 years, with a median of 8.8 years with a male-to-female ratio of 1.3:1. The overall most common indication for biopsy was nephrotic syndrome (NS) including steroid-resistant NS, followed by proteinuria and nephritic syndrome. Majority of the lesions included in the study were primary glomerular disease (71%) while secondary glomerular disease amounted to 18%. The spectrum of disease includes minimal-change disease (MCD) (27.7%), followed by membranoproliferative glomerulonephritis (MPGN) (15.38%), focal segmental glomerulosclerosis (FSGS) (9.23%), lupus nephritis (7.7%), hemolytic uremic syndrome (7.7%), MPGN (6.15%), advanced renal disease (6.15%), membranous glomerulonephritis (3.07%), and crescentic glomerulonephritis (3.07%). This study is an important contribution to the epidemiology of pediatric renal disease spectrum in the Indian population. We conclude that MCD is the most common pathology seen in pediatric age group, with NS as the most common indication for biopsy. There is a steady increase in the incidence of FSGS in the pediatric population with frequent relapses and an increase in the incidence of steroid resistance. However, with the use of immunofluorescence and EM, an accurate diagnosis is possible, so an early renal biopsy should be planned in nonresponding cases and at times even before starting the treatment for appropriate treatment.