Histopathologic Characteristics of Steroid-Resistant Nephrotic Syndrome in Children in Iran

Nephrotic syndrome is the most common chronic renal disease in children. Mostly, it is controlled by steroids. Many underlying pathologies exist in patients with steroid-resistant nephrotic syndrome (SRNS). Among them are ‘focal segmental glomerulosclerosis (FSGS) and ‘minimal change disease’ (MCD). Examining patients’ clinicopathologic characteristics can be helpful by giving an insight into the etiology of steroid resistance and determining patient prognosis. This cross-sectional study was performed in ‘Children’s Medical Center’ between 2001 and 2011. From 150 patients biopsied, seventy-one children with SRNS, aged 1-14 years, were included. Among 150 patients biopsied, 71 children (47.3%) had steroid-resistant nephrotic syndrome. Forty-four (62%) of these were boys. Upon pathologic investigation of SRNS cases, FSGS came in first, with the highest prevalence at a rate of 32.4%, and MGN came in last, at a rate of 5.6%. The mean age of disease onset was 4.7 years and the mean age of undergoing biopsy was six years. In this study, the predominant pathologic pattern of steroid-resistant nephrotic syndrome was FSGS, a finding similar to that of most studies conducted in this field. MCD was observed in 21.1% of patients, which indicates the variety in reporting renal lesions, particularly, regarding the diagnoses of MCD, mesangio-proliferative glomerulonephritis and early stages of FSGS.