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CORRESPONDENCE
Year : 2019  |  Volume : 2  |  Issue : 2  |  Page : 104-105

Renal histopathological profile of Bangladeshi children in a tertiary care hospital


Department of Paediatric Nephrology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Date of Web Publication4-Dec-2019

Correspondence Address:
Afroza Begum
Department of Pediatric Nephrology, Room No. 321, Block-D, 2nd Floor, Bangabandhu Sheikh Mujib Medical University, Dhaka-1000
Bangladesh
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AJPN.AJPN_20_19

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How to cite this article:
Begum A, Santa SM, Al Mamun A, Jesmin T, Huque SS, Roy RR. Renal histopathological profile of Bangladeshi children in a tertiary care hospital. Asian J Pediatr Nephrol 2019;2:104-5

How to cite this URL:
Begum A, Santa SM, Al Mamun A, Jesmin T, Huque SS, Roy RR. Renal histopathological profile of Bangladeshi children in a tertiary care hospital. Asian J Pediatr Nephrol [serial online] 2019 [cited 2020 Jul 2];2:104-5. Available from: http://www.ajpn-online.org/text.asp?2019/2/2/104/272307



Sir,

Information on the histopathological profile of children with glomerular diseases from developing countries is limited and variable. We retrospectively reviewed the clinical records of 275 children who underwent kidney biopsy for suspected glomerulonephritis (GN) at the Department of Pediatric Nephrology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, over a 5-year period, between July 2012 and June 2017. All kidney biopsies were percutaneous, performed using standard practices worldwide, and evaluated by light and immunofluorescence microscopy. Patients with congenital nephrotic syndrome, inadequate biopsy (n = 22), and incomplete clinical records (n = 58) were excluded from the study, and 195 patients with a median (range) age of 144 (8–204) months, of whom 60% were boys, were included in the study. The chief indications for biopsy included nephrotic syndrome, with steroid resistance (31.3%); presentation at <1 year or above 10 years of age (22%); atypical presentation with gross hematuria, impaired renal function, hypocomplementemia, or persistent hypertension (6.7%); suspected secondary cause (12.3%); or, in steroid-dependent patients, before therapy with calcineurin inhibitors (12.8%). Other indications included rapidly progressive GN, delayed resolution of postinfectious GN, and to determine the etiology of unknown glomerular chronic kidney disease.

The most common histopathological diagnosis was mesangial proliferative GN (32.8%), followed by membranoproliferative GN (20.5%), minimal change disease (13.3%), lupus nephritis (9.2%), focal segmental glomerulosclerosis (6.2%), crescentic GN (6.2%), immunoglobulin (Ig) IgA nephropathy (4.6%), Henoch–Schonlein purpura nephritis (4.1%), and diffuse proliferative GN (3.1%). Among 18 patients with lupus nephritis, 13 showed Class IV nephritis, 4 biopsies showed Class II, and one had Class V lupus nephritis.

The finding of mesangioproliferative GN as the most common histopathological type of GN, is similar to those of previous studies from Bangladesh, including our center,[1] and from other countries.[2],[3] The lack of predominance of minimal change or focal segmental glomerulosclerosis as the predominant histopathology, and the low rate of reporting of IgA nephropathy in our study, as compared to findings from other countries,[4],[5],[6] might reflect differences in practice indications for biopsy, referral bias, or geographical variations in the prevalence of glomerular diseases. The findings of Class IV nephritis as the most common histopathological subtype are consistent with what is understood of childhood-onset systemic lupus erythematosus.[7]

Renal biopsy reliably enables the diagnosis and assessment of the prognosis of pediatric glomerular diseases. An understanding of the relative prevalence of various histopathological subtypes is useful in predicting the underlying histology and guiding the management of children with glomerular diseases.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Begum A, Mamun AA, Jesmine T, Rahman M A, Huque S S, Muin Uddin G, et al. Pattern of glomerular diseases in Bangladeshi children: A clinico-pathological study. Nephrologia Urologia2017;1:7-9.  Back to cited text no. 1
    
2.
Al-Rasheed SA, Al-Mugeiren MM, Al-Salloum AA, Al-Sohaibani MO. Childhood renal diseases in Saudi Arabia. A clinicopathological study of 167 cases. Int Urol Nephrol 1996;28:607-13.  Back to cited text no. 2
    
3.
Bircan Z, Yavuz Yilmaz A, Katar S, Vitrinel A, Yildirim M. Childhood idiopathic nephrotic syndrome in Turkey. Pediatr Int 2002;44:608-11.  Back to cited text no. 3
    
4.
Crensiglova C, Rehme BB, Kinasz LR, Chula DC, Nascimento MM, Soares MF. Frequency and clinical histological analysis of glomerular diseases in a tertiary hospital in southern Brazil. J Bras Nefrol 2016;38:42-8.  Back to cited text no. 4
    
5.
Asinobi AO, Ademola AD, Okolo CA, Yaria JO. Trends in the histopathology of childhood nephrotic syndrome in Ibadan, Nigeria: preponderance of idiopathic focal segmental glomerulosclerosis. BMC Nephrol 2015;16:213.  Back to cited text no. 5
    
6.
Bonilla-Felix M, Parra C, Dajani T, Ferris M, Swinford RD, Portman RJ, et al. Changing patterns in the histopathology of idiopathic nephrotic syndrome in children. Kidney Int 1999;55:1885-90.  Back to cited text no. 6
    
7.
Thakur N, Rai N, Batra P. Pediatric lupus nephritis-review of literature. Curr Rheumatol Rev 2017;13:29-36.  Back to cited text no. 7
    




 

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