Clinical and histopathological study of renal biopsy in Nepalese children: A single center experience

Abstract

Background: Glomerular diseases are important causes of morbidity and mortality among children in developing countries. Renal biopsy is the gold standard for determining histological diagnosis, prognosis, and therapy options. This study aimed to investigate the clinical, histopathological, and direct immunofluorescence findings of renal biopsy results in Nepalese children under 18 years old.

Methods: In this retrospective cross-sectional study, the available data from children who had undergone kidney biopsy between 2016 and the end of 2020 were evaluated. Demographic data, indications of biopsy, histopathologic findings, and direct immunofluorescence findings were collected and presented.

Results: The mean age of the patients was 12.14 ± 4.07 years. Male/female ratio was 1:1. The majority of biopsy cases were aged between 11-15 years of age. The most common indication for biopsy in children was nephrotic syndrome (68.25%). Lupus nephritis with 28 cases (22.22%) had the highest frequency in overall renal biopsies. Minimal change disease (MCD) with 22 cases (17.46%) followed by Ig A nephropathy with 16 cases (12.69%) were the most frequent primary glomerulonephritis. Lupus nephritis showed full house positivity, and MCD showed full house negativity in all Direct immunofluorescence (DIF) parameters, whereas immunoglobulin A nephropathy showed 100% positivity in Ig A in DIF.

Conclusions: Nephrotic syndrome was the most common indication for renal biopsy. The most common primary glomerulonephritis was MCD, while secondary glomerulonephritis was lupus nephritis. Clinical data, light microscopy, and direct DIF played an integral role in the overall final diagnosis.

Fig 1. Age distribution of paediatric kidney patients (N = 126).

Fig 2. Clinical indications of renal biopsy in children (N = 126).

Fig 3. Histopathological findings in glomeruli.

Fig 4

a WHO classification of Lupus Nepritis (N = 28). b. Activity chronicity index of Lupus Nephritis (N = 28).

Fig 5. Classification of crescentic glomerulonephritis (N = 10).

Fig 6. Histopathological findings of Ig A nephropathy (N = 16).

Fig 7. Percentage positivity of different immunoglobulins.

Note: 2+ or more were considered positive on DIF.

Fig 8

a Lupus nephritis Class IV with mesangial and endocapillary proliferation (H&E stain x400). b. DIF shows full house positivity.

Fig 9

a. Ig A nephropathy with increased mesangial matrix and cellularity (arrows) (PAS stain x400). b DIF shows strong positivity with Ig A, C3, kappa and lambda.