THE PAUCITY OF MINIMAL CHANGE DISEASE IN ADOLESCENTS WITH PRIMARY NEPHROTIC SYNDROME

Data are sparse regarding the histological lesions associated with the primary nephrotic syndrome in adolescents. To our knowledge there are only two published articles that have specifically addressed the hist opathological lesions that typify idiopathic nephrotic syndrome in the adolescent population. We reviewed our experience from the last 14 ye ars of children between the ages of 12 and 18 years who were referred to our center for the evaluation of the nephrotic syndrome, A total of 29 adolescents met the inclusion criteria for this review. All patien ts were biopsied prior to the initiation of treatment. The sex ratio c onsisted of 52% males and 48% females and the racial breakdown was lar gely African-American, with 83% black adolescents, 7% Hispanic, and 10 % Caucasian patients. Minimal change nephrotic syndrome (MCNS), the pr edominant lesion of children at an early age, was noted in only 20% of patients. The majority of patients (55.2%) had focal segmental glomer ulosclerosis (FSGS); 7% had IgM nephropathy and 3.5% had diffuse mesan gial hypercellularity. Only 7% of biopsied adolescents had membrano-pr oliferative glomerulonephritis. Our results indicate that the most com mon lesion in this predominantly African-American patient population i s FSGS, with only a small number showing MCNS. Thus, in our experience derived from a racially mixed population, adolescents with the nephro tic syndrome are less likely to have MCNS than younger children.