Renal Pathology in Adult Onset Idiopathic Nephrotic Syndrome A Study of 100 Cases

This study was carried out in the nephrology unit to Rajshahi Medical College Hospital, Rajshahi during the period 2003-2005. Renal biopsy was done in one hundred adult patients with Nephrotic syndrome to evaluate the histopathological pattern. Mesangioproliferative GN was the commonest underlying cause which is found in 36 (40%) cases. MPGN is followed by minimal change disease in 22 (24.44%), membranous GN 16 (17.77%), membranoproliferative glomerulonephritis 12 (13.33%), Focal segmental glomerulosclerosis 3 (3.34%) and IgA nephropathy 1 (1.12%) cases. This is concordant with other studies. TAJ 2007; 20(2): 140-143 1 Medical officer, Rajshahi Medical College Hospital, Rajshahi. 2 Professor, Department of Medicine, Rajshahi Medical College, Rajshahi. 3 Resident Physician (Medicine), Rajshahi Medical College Hospital, Rajshahi. 4 Associate Professor, Department of Nephrology, Rajshahi Medical College, Rajshahi. 5 Deputy Commandant and Classified Specialist in Pathology, Armed Forces Institute of Pathology. Introduction Like fever, Nephrotic syndrome (NS) is not a disease, rather it is the manifestation of a wide variety of underlying disease process. NS is a clinical condition characterized by massive urinary loss of protein (primarily albumin), which leads to hypoproteinemia (hypoalbuminemia) and edema. Hyperlipidemia, hypercholesterolemia, and increased lipiduria usually are associated. Nephrotic syndrome results from a wide range of etiological factors. Histological examination of the biopsied kidneys remains the gold standard for renal diagnosis. In 1951, Inverson and Brun reported the first large series of needle biopsies of the kidney. The primary aim of this study is to determine the etiology of adult nephrotic syndrome and the histological pattern of idiopathic adult nephrotic syndrome. The idiopathic nephrotic syndrome has distinctive histopathologic and immunologic variations upon which steroid responsiveness and prognosis depends. Materials and methods This study was carried out in the nephrology unit to Rajshahi Medical College Hospital, Rajshahi during the period 2003-2005. One hundred adult (age more than 18 years) patients with nephrotic syndrome as diagnosed by massive proteinuria >3.5 gm/day, serum albumin <30gm/L, evidence of fluid retention or oedema were included in this study. All the cases were studied with meticulously taken history and clinical findings. Patients who self-discharged themselves before the diagnostic workout was complete were excluded from the study. All the patients were investigated for the possible causes of secondary nephrotic syndromes like blood sugar 2 hours after break fast, HBsAg, anti HCV and for selected patient with suspected systemic lupus erythematosusAnti nuclear factor (ANF), and anti-ds DNA. All the patients were evaluated with routine and microscopic examination of urine, blood urea, serum creatinine, urinary total protein, serum cholesterol, serum total protein, serum albumin, serum globulin, serum albumin-globulin ratio ultrasonography of the genitourinary system for the estimation of kidney size. Kidney biopsy was done in all cases. Kidney biopsy was done keeping the patient in prone position with “True Cut needle biopsy” with all aseptic precaution. Two samples were taken one in normal saline and another in 10% formalin. Sample in normal saline was freezed and sent to Dhaka by keeping the freezing temperature. Sample in formalin was sent to Dhaka normally. Both the samples were sent to Brig Gen (Dr.) Muhammad Jalal Uddin, Deputy Commandant and classified specialist in pathology, Armed forces Institute of Pathology, in JR Pathology Services, 16, Green Super Market, 3rd Floor, Green road, Dhaka1205. Both light microscope and direct immunofluorescence study were used for biopsy report.