Histomorphologic analysis in adult nephrotic syndrome: Changing scenario

Background: Nephrotic syndrome (NS) is the manifestation of a wide variety of underlying disease processes. The spectrum of diseases causing NS is changing globally in the last few decades. In this context, renal biopsy findings in adult nephrotics studied during 1996-1998 are revisited Materials and Methods: The cross-sectional analytical study was conducted during the period May 1996-July 1998 at a medical college in Western India. Renal biopsies were performed on 72 adult nephrotic patients. Histopathology reports along with clinical data reviewed and analysed. Results: Primary glomerular diseases accounted for 70% of cases, while amyloidosis was the most common secondary glomerular disease. Mesangiocapillary glomerulonephritis was the most common cause of primary NS followed by minimal change disease (MCD) and membranous glomerulonephritis (MGN). Previous studies showed that MGN was the most common cause of adult NS. More recent studies have shown that the focal segmental glomerulosclerosis (FSGS) is increasing significantly with reduction in diffuse proliferative glomerulonephritis while there was no major change in incidence of other diseases. FSGS which is the most common cause of NS in adult in other studies accounted for only 8.5% in our study. Immunofluorescence and electron microscopy was not done in these cases resulting in more cases of MCD and less number of IgA nephropathy and FSGS. Conclusion: In view of changing spectrum of renal diseases, evaluation of adult NS should be done on a regular basis for the correct diagnosis