NO PROLIFERATIVAS. – Glomerulonefritis de cambios mínimos. – Glomerulosclerosis segmentaria y focal. – Glomerulonefritis membranosa. GLOMERULOPATIAS Cinthia Alt. Ramirez 30 noviembre Epidemiología Clasificación etiológica Primarias y Secundarias. Las GN. Clasificación e recursos externos Glomerulopatía ou glomerulite é o termo que define ás diversas doenzas que afectan ao glomérulo renal do nefrón, unha.
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Study of nephrotic syndrome in children: Importance of light, immunoflourescence and electron microscopic observations to a correct classification of glomerulopathies. To evaluate the contribution of electron microscopy EM to the accurate diagnosis of glomerulopathies in childhood nephrotic syndrome NS in a developing country.
Patients’ demographic, clasifciacion, laboratory, and biopsy data were retrieved from case records and biopsy reports. Renal biopsies were studied by light microscopy, immunoflourescence, and EM.
The mean age of 74 children was EM was useful in The results demonstrate that the ultrastructural study is both helpful and essential to a correct classification of glomerular diseases underlying NS in children in nearly all cases and whenever feasible this should be used in the pathologic evaluation of renal biopsies.
Children, Nephrotic syndrome, Renal biopsy, Morphological patterns, Ultrastructural study. Diagnostic renal pathology is an integrative process, wherein an accurate diagnosis of glomerular diseases, requires a correlative approach incorporating the clinical data, the serologic tests and the complete pathologic evaluation of renal biopsy by light microscopy LMimmunoflourescence IFand electron microscopy EM.
Only few studies are available on the current position of EM in the investigation of renal biopsies in developing countries and still fewer, on the utility of EM in the study of childhood renal diseases.
Pakistan too, being a developing country, lacks widespread availability of EM facilities. In recent reviews of completely worked-up renal biopsies in patients with nephrotic syndrome NSwe have found that the pattern of glomerular diseases, in both the children and the adults, is more akin to that reported recently in developed parts of the world, rather than the tropical pattern reported in earlier studies from Pakistan.
We have earlier reported on the role of IF and EM in the evaluation of renal biopsies in NS in a study that included both the children and the adults. Since, age is an important determinant of the glomerular lesions underlying NS and the lesions differ markedly among the children and the adults, we contemplated to evaluate the relevance of ultrastructural study in the accurate evaluation of renal biopsies of the glomerulopathies underlying NS in children from Pakistan.
The study was approved by the ethical review committee of SIUT. Renal allograft biopsies as well as native renal biopsies performed for other indications, such as, acute renal failure ARF were excluded. Patients’ demographic, clinical and laboratory data, including age, sex, renal functions and h urinary protein were retrieved from case files. Renal biopsies were undertaken in all cases using Tru-cut needle under ultrasound guidance after obtaining informed consent from patients or their parents.
The renal biopsies were processed for LM examination according to established protocols, as described in detail in our earlier study. Further special stains were done, if needed. Tissue samples for EM were processed according to established techniques.
Glomerulopatía – Wikipedia, a enciclopedia libre
Ultra-thin sections nm were cut on Leica ultramicrotome. The diagnostic role of the EM study was considered essential if the final diagnosis could not have been clasifucacion in the absence of EM study. The contribution was considered helpful in cases, in which, although the diagnosis could have been reached based on the combined LM and IF studies, the EM confirmed the diagnosis, especially by excluding diagnoses based exclusively on EM findings.
EM study was considered noncontributory if the final diagnosis could have been reached with out it. The final correlative diagnosis gllmerulopatias glomerular diseases was based on renal biopsy findings by LM, IF and EM and the correlation of these pathologic findings with the clinical, laboratory and serological results.
Established diagnostic criteria were used for the diagnosis of specific glomerular diseases. The demographic characteristics of 74 children showed the mean age of There were 38 All children presented with NS. The mean h urinary protein excretion was 4. The mean serum albumin was 1. Hematuria was detected in 15 Positive antinuclear antibody ANA test was found in 8 Low complement factor C3 was found in 17 Anti-streptolysin O ASO titer was elevated in two cases.
As is evident, the focal and segmental sclerosing lesion was the most common morphological pattern, followed by minor changes and mesangial proliferative pattern. Other morphological appearances were rare. The final diagnoses arrived at claificacion combining the LM, IF and EM studies with the clinical and the serological results, are shown in Table 2. It is apparent from these tables that the morphological patterns of glomerular injury as seen on LM are not synonymous with the final diagnoses, the later can only be reached by a correlative approach combining information from LM, IF and EM study with the clinical, laboratory and serological data.
Finally, the contribution of the EM study of renal biopsies to the final diagnostic categories is shown in Table 3. This clearly shows that the EM study is useful in a vast preponderance of cases of glomerular diseases in childhood NS. Morphologic findings observed on light microscopy in renal biopsies in 74 children with idiopathic nephrotic syndrome. Final diagnosis based on correlating LM, IF and EM with clinical and serologic findings in 74 children with nephrotic syndrome.
Contribution of electron microscopic study to the final diagnosis of glomerular diseases in 74 children with nephrotic syndrome. The current study is an important contribution to the field of pediatric nephropathology for several reasons; it is the first study from any developing country and from Pakistan on this subject and the second to the only published study from USA on children presenting with NS.
The previously mentioned, and the exclusive, study on this subject from the USA had included 48 children. Overall, the EM study was useful in It was noncontributory in only 2. These results show that the EM study is more useful in children with NS in comparison to adults. Regarding specific diseases, the findings from the current study demonstrate that FSGS is the leading cause of NS in this cohort of children.
This is concordant with several recent studies from around the world, which show that the incidence of this lesion is on the rise in children with NS 9. Glomerulopatlas our previous analysis of percutaneous native renal biopsies over 14 year period, this lesion closely followed MCD in children as a cause of idiopathic NS INS.
The evidence from the current study suggests that FSGS has likely surpassed MCD as the leading cause of INS in the pediatric population, as reported previously in the adults from our center. MCD was the second most frequent lesion underlying NS in children in this study.
It used to be the leading cause of INS in children, but many researchers have found a declining prevalence of this lesion throughout the world in recent years. We acknowledge the fact the potential role of EM in establishing a diagnosis of MCD in a pediatric population is not without controversy, especially, in the perspective of developing countries.
The definitions of essential and helpful roles of EM have been derived from studies done in developed countries, and may not be equally relevant for resource constrained developing countries. It could be argued that children presenting with nephrotic-range proteinuria and a normal appearing renal biopsy on LM could be presumed to have MCD. Nevertheless, standard of care in Western countries would dictate that EM is deemed essential.
Portions of two capillary loops showing extensive fusion of foot processes in a case of minimal change disease. Glomerular basement membrane is normal. No electron dense deposits are seen. Transmission electron microscopy, uranyl acetate and lead citrate, x 8, IgMN has also emerged as an important cause of idiopathic NS in children in our part of the world.
Lupus nephritis LN is an important cause of renal morbidity and mortality in older children and teenagers. In some of these patients, the EM study provides the key information that can not be otherwise obtained. The two other groups of glomerular diseases for which the EM study was essential were the mesangiocapillary GN MPGN and the glomrrulopatias glomperulopathies. Similarly, EM study clwsificacion essential for the correct diagnosis of all cases of hereditary glomerular diseases.
It is interesting to note that TBMD typically does not cause NS, but occasional cases have been described with nephrotic range proteinuria. Genetic and pedigree analysis can resolve the differential in such cases.
No family history was available of renal disease in our case and genetic testing could not be lgomerulopatias due to non-availability of this facility. Peripheral capillary loops showing numerous electron dense deposits in subendothelial location in a case of df glomerulonephritis, type I. Medium magnification view of glomerular basement membrane GBM showing focal thickening and rarefaction of the lamina densa of the GBM in a case of Alport syndrome. Foot processes are partially fused.
Transmission electron microscopy, uranyl acetate and lead citrate, x 25, In conclusion, the findings from this study show that the EM study is both clasiticacion and essential in the diagnosis of the specific glomerulopathies causing NS in children in nearly all cases and should be employed routinely in the pathologic investigation glomerulopatis renal biopsy material whenever possible or at least the tissue for such study procured glomerulopatiqs preserved appropriately.
The contribution of the ultrastructural study to the investigation of the renal biopsies in childhood NS in a developing country like Pakistan is as pertinent as in the developed countries. In the developing countries, establishment of national reference renal pathology laboratories with the EM facilities, may be a feasible option where the renal samples from other laboratories can clasificacino sent for analysis, till such facilities are widely available.
We acknowledge with gratitude the help and efforts of Dr. The authors declare that there is no conflict of interest associated with this manuscript. Laboratory investigation of renal biopsy specimen.
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Role of immunoflourescence and electron microscopy inthe evaluation of renal biopsies in nephrotic syndrome in a developing country.
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