Authors
Mary Gracea
a. Department of Medicine, Government Medical College, Thrissur;
VinuThomasb
b. Indian Medical Association, Anayara PO, Trivandrum*
Abstract
The main aim of this study was to elucidate a relationship between the clinical parameters and renal histology. The practice followed in pediatric NS and to a lesser extent in adolescent NS is to offer a trial of steroid therapy and deferring renal biopsy as per response. This practice is mainly based on the statistical fact that majority of NS patients in these age group were having MCNS and hence steroid responsive. Although in adult NS, this statistical prediction does not corroborate, there are well defined clinical parameters like age, onset, temporal profile, hypertension, urinary sediment, renal failure, degree of proteinuria etc., which can differentiate MCNS from others. An attempt has been made in this study to clarify such clinical parameters and then to confirm their relationship to the morphological picture by renal biopsy.
Adult patients with primary Nephrotic syndrome who came to Thrissur Medical College for treatment were selected for this study. The following features- age, gender, duration and degree of proteinuria, hematuria, oliguria, hypertension, edema, pleural effusion, ascites, hemoglobin, total and differential count, urine albumin, urine sediment, 24 hour urinary protein, renal function tests, serum cholesterol, serum albumin and ultrasound of the abdomen of these patients were studied. Prior to renal biopsy each patient was analyzed in detail and the possible histopathological lesion predicted. Renal biopsy was done with automated Tumour biopsy gun under ultrasonic guidance with all necessary precautions in these patients. The tissue was analyzed by light and immunofluorescence microscopy. The histopathological lesions were correlated with demographic, clinical and laboratory parameters. The predictive value of these clinical and laboratory parameters on the renal histology were sought. Results were analyzed using standard statistical methods.
We strongly recommend renal biopsy in all adult patients with NS prior to steroid treatment.
Keywords: Nephrotic syndrome, Renal biopsy, Histology