Immune deposits and mesangial hypercellularity in minimal change nephrotic syndrome: clinical relevance.
Occasional patients with nephrotic syndrome and minimal histologic change demonstrate glomerular deposition of small amounts of immunoglobulin and complement. Some consider this a disease distinct from MCNS. To investigate the clinical importance of immune deposits and mesangial hypercellularity in the initial biopsy, the clinical records, follow-up data, and renal biopsies of 68 patients (ages 6 months to 16 years) with MCNS by light microscopy were reviewed. Among 68 patients followed a mean of 6.2 years, eight of 25 patients with immune deposits on initial renal biopsy were steroid nonresponsive. Only one of 43 patients without immune deposits was steroid nonresponsive (P = 0.00005). Of 44 patients with normal mesangial cellularity, 31 experienced fewer than three relapses a year, whereas of 15 patients with mesangial hypercellularity, only six experienced fewer than three relapses a year (P = 0.035). The data suggest that immune deposits and increased mesangial cellularity in children with NS and minimal light microscopic change may predict the clinical course.
D000293:Adolescent; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D002699:Chlorambucil / Q000627:therapeutic use; D003176:Complement C3 / Q000032:analysis; D003181:Complement C4 / Q000032:analysis; D003520:Cyclophosphamide / Q000627:therapeutic use; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis; D007074:Immunoglobulin G / Q000032:analysis; D007075:Immunoglobulin M / Q000032:analysis; D007136:Immunoglobulins / Q000032:analysis; D007223:Infant; D007678:Kidney Glomerulus / Q000166:cytology / Q000276:immunology*; D008297:Male; D008856:Microscopy, Fluorescence; D009404:Nephrotic Syndrome / Q000188:drug therapy / Q000276:immunology*; D011241:Prednisone / Q000627:therapeutic use; D012008:Recurrence
D003176:Complement C3; D003181:Complement C4; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D007136:Immunoglobulins; D002699:Chlorambucil; D003520:Cyclophosphamide; D011241:Prednisone