Changing trends of histopathology in childhood nephrotic syndrome

This study was conducted to analyze the trend of histopathologic subtypes i n idiopathic nephrotic syndrome (INS) in a homogenous racial group in India population, A prospective analysis of 400 consecutive children with INS wa s performed. Kidney biopsies were performed according to standard indicatio ns. Steroids were administered following the Arbeitsgeminschaft fur Padiatr ische Nephrologie protocol. Cyclophosphamide was administered to children i n the frequent-relapser, steroid-dependent, and steroid-nonresponder catego ries. Of the various histopathologic subtypes, focal segmental glomeruloscl erosis (FSGS) was the most common (87 of 222 subtypes; 39.1%), Children who underwent biopsy between July 1992 and December 1996 (group B, n = 157) we re compared with our initial published data of biopsies performed between J anuary 1990 and June 1992 (group A, n = 65), with similar indications for b iopsy in both groups. The incidence of FSGS was significantly greater in bi opsies performed in the recent period (group B, 47% versus group A, 20%; P = 0.0002), The different clinical and biochemical parameters were also anal yzed to differentiate FSGS from the other 2 subtypes, Hypertension (P = 0.0 05), renal insufficiency at presentation (P = 0.001), and steroid resistanc e (P = 0.0006) were significantly greater in children with FSGS, On follow- up (mean, 5.4 years), children with FSGS were at a significantly greater ri sk for developing renal insufficiency (P = 0.0001). We conclude there is a shift toward an increasing prevalence of FSGS over the years in the Indian population. This trend has immense therapeutic and prognostic significance. (C) 1999 by the National Kidney Foundation, Inc.