Value of electron microscopy in the diagnosis of childhood nephrotic syndrome

The value of the ultrastructural study of the renal biopsy was investigated in a series of pediatric patients with nephrotic syndrome. Forty-eight cas es of renal biopsies with clinical data were reviewed and divided into diag nostic groups. The contribution of electron microscopy to the final diagnos is was graded as essential-diagnosis could not be reached without it; suppo rtive it increased the level of confidence in the final diagnosis; and nonc ontributory. In this series of renal biopsies from 48 children with nephrot ic syndrome resistant or nonresponsive to therapy, the most frequent diagno sis was minimal change disease, present in 42% of the patients. The contrib ution of the electron microscopic study to the final diagnosis was essentia l in 73% of the series, and was supportive in a further 27%. Therefore, it is concluded that the ultrastructural study was an essential component in t he study of the renal biopsy in children with nephrotic syndrome, suggestin g that electron microscopy needs to continue to be performed for all these patients.