Single-center Experience of Histopathological Spectrum and Treatment Profile in Adolescent-onset Nephrotic Syndrome in India

Guidelines suggest a biopsy-tailored treatment rather than glucocorticoids as initial therapy for adolescent-onset nephrotic syndrome (NS) as minimal change disease is more common in younger children. There is a paucity of data regarding the clinical course and renal histopathological findings in this population. This study analyzed the clinical course and histological spectrum of adolescent-onset NS.
In this retrospective study, we evaluated the medical records of patients with adolescent-onset NS who received treatment at the Department of Pediatrics, SVPPGIP & SCB Medical College, Cuttack, Orissa, India, between January 2010 and January 2017. Patients with congenital, infantile, childhood-onset, and secondary causes of NS were excluded. All children were treated as per the Indian Society of Pediatric Nephrology (ISPN) protocol.
The data of 48 adolescents were analyzed. The median age at onset of disease was 12 years (range: 10-14 years), and 68.75% (33/48) of the patients were males. Steroid-dependent NS (SDNS, 43.7%, 21/48) was the most common indication followed by frequently relapsing NS (FRNS, 29.1%, 14/48). Prednisolone with tacrolimus (37.5%, 18/48) and mycophenolate mofetil (35.4%, 17/48) were the most commonly used treatments. Biopsy results showed that minimal change disease (MCD) was the most common histopathological subtype (37.5%, 18/48) closely followed by focal segmental glomerulosclerosis (FSGS, 31.2%, 15/48). Most of the cases responded to a combination of prednisolone and MMF, cyclophosphamide, or tacrolimus (23%).
The most common underlying cause of adolescent-onset nephrotic syndrome as assessed histopathologically is MCD, closely followed by FSGS with most of the cases responding to a combination of prednisolone and mycophenolate mofetil, cyclophosphamide, or tacrolimus.