CHILDHOOD STEROID-SENSITIVE NEPHROTIC SYNDROME - DOES THE HISTOLOGY MATTER

Renal biopsy specimens from 51 children with steroid-sensitive nephrot ic syndrome who were following a frequently relapsing or steroid-depen dent course were reviewed by two histopathologists. In all cases the b iopsy was performed prior to the commencement of an 8-week course of c yclophosphamide. The clinical courses of these patients both prebiopsy and for a minimum of 2 years after completion of cyclophosphamide the rapy were analyzed using retrospective case note analyses. The distrib ution of histologic diagnoses differed significantly from that reporte d by the International Study of Kidney Disease in Children in their st udy of children who underwent biopsy at the time of presentation, ther e being an excess of focal segmental glomerulosclerosis and mild mesan gial hypercellularity in this series. The prebiopsy clinical course di d not predict for histologic diagnosis, and there was no correlation b etween prebiopsy course or histology and postcyclophosphamide course. The findings of this study support the clinical impression that steroi d sensitivity rather than histology is the major determinant of progno sis in childhood nephrotic syndrome and that frequency of relapse alon e is not an indication for biopsy. (C) 1996 by the National Kidney Fou ndation, Inc.