1. Muhammad Imran 2. Zulfiqar Ali Rana 3. Muhammad Waqar Rabbani 

4. Imran Iqbal 5. Hashim Raza

1. Asstt. Prof. of Paediatric Nehprology, 2. Asstt. Prof. of Paediatric Oncology 3. Assoc. Prof. of Paediatrics 

4. Prof. of Paediatrics, 5. Medical Officer, The Children Hospital & ICH Multan

ABSTRACT

Objective: To determine the frequency of various histopathological lesions in children with steroid resistant nephrotic syndrome (SRNS) presenting to the Children's Hospital & the Institute of Child Health, Multan.

Study Design: Retrospective observational study 

Place and Duration of Study:  This study was conducted at the Department of Paediatric Nephrology, The

Children’s Hospital and The Institute of Child Health, Multan, Pakistan from October 2005 to December 2012. Materials and Methods: Medical record of 152 children with SRNS, who were biopsied, was reviewed. All SRNS patients, both initial steroid resistant and late non-responders were included in the study.

Results: Out of the total 152 patients, 98 (64.5%) were males and 54 (35.5%) females, with a male to female ratio of 1.8: 1. Mean age and standard deviation of patients was μ 8.11 + 3.58 years with age range of 1 to 15 years. Histopathological spectrum showed focal segmental glomerulosclerosis (FSGS) as the commonest (59; 38.81%) lesion followed by mesangioproliferative glomerulonephritis (MesPGN) (40; 26.31%), minimal change disease (MCD) (35; 23.02%) and mesangiocapillary glomerulonephritis (MCGN) (13; 08.55%). Four (2.63%) patients had membranous nephropathy. One patient of renal amyoidosis was also diagnosed on renal biopsy.

Conclusion: Overall FSGS was the commonest lesion followed by MesPGN, MCD, and MCGN. IgMN was an associated finding in 25% cases of MesPGN. FSGS was significantly more common among children >10 years. MCD was significantly more common among children 1-5 years. MesPGN and MCGN were significantly more common among children >5 years.

Key Words: Steroid resistant nephrotic syndrome, Renal biopsy, Histopathological pattern, Children