Pattern of steroid-resistant nephrotic syndrome in children and the role of histopathology: A single-centre study

Background. Steroid-resistant nephrotic syndrome (SRNS) is a common problem in paediatric nephrology practice. There is currently little information on the spectrum of histopathological lesions in children presenting with SRNS in India and other south-east Asian countries. Objective. To determine the histopathological lesions in children presenting with SRNS at our institution. Methods. The study was conducted at Sardar Vallabh Bhai Patel Postgraduate Institute of Paediatrics and Sriram Chandra Bhanja Medical College, Cuttack, Odisha, India, from January 2009 to March 2013. All children aged 1-14 years presenting with primary SRNS and in whom renal biopsies were performed were included in the study. Their demographic, clinical, laboratory and histopathological data were retrieved from files and original renal biopsy forms. Results. A total of 40 children had a clinical diagnosis of SRNS; 23 were males and 17 females (male: female ratio 1:35). Their mean age (+/- standard deviation) was 4.47 (+/- 2.98) years (range 1-14 years). The histopathological lesions seen on renal biopsy specimens comprised minimal-change disease (MCD) (n=18), focal segmental glomerulosclerosis (FSGS) (n=12), immunoglobulin A nephropathy (IgAN) (n=5), immunoglobulin M nephropathy (n=2), membranous nephropathy (n=2) and idiopathic mesangial proliferative glomerulonephritis (n=1). Conclusion. MCD is the predominant lesion in children with SRNS at our institution, followed by FSGS and IgAN.