Clinicopathological Correlation in Adult Nephrotic Syndrome
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.
When publishing with Kerala Medicial Journal (KMJ), authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal. Work includes the material submitted for publication and any other related material submitted to KMJ. In the event that KMJ does not publish said work, the author(s) will be so notified and all rights assigned hereunder will revert to the author(s).
The assignment of rights to KMJ includes but is not expressly limited to rights to edit, publish, reproduce, distribute copies, include in indexes or search databases in print, electronic, or other media, whether or not in use at the time of execution of this agreement.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
The author(s) hereby represents and warrants that they are sole author(s) of the work, that all authors have participated in and agree with the content and conclusions of the work, that the work is original, and does not infringe upon any copyright, propriety, or personal right of any third party, and that no part of it nor any work based on substantially similar data has been submitted to another publication.
