title: Clinicopathological features of atypical nephrotic syndrome in Jamaican children.
abstract: OBJECTIVE
  To document the histopathological spectrum of atypical nephrotic syndrome in Jamaican children and to make clinicopathological correlations which will assist physicians in identifying patients needing nephrology consultation.
  
  
  METHODS
  This was a retrospective review of renal biopsy data of Jamaican children who were referred to the University Hospital of the West Indies and the Bustamante Hospital for Children between January 1985 and December 2008. The study population consisted of children < 12 years old with atypical nephrotic syndrome.
  
  
  RESULTS
  Biopsies were done in 157 children--85 males and 72 females (mean age 8.91 +/- 3.44 years). Indications for biopsy were steroid resistance (35%), frequent relapses (8.9%) and other atypical presentations (56.1%). Overall, mesangial proliferative glomerulonephritis (MesGN) was the commonest histology (49/157, 31.2%), followed by minimal change disease (MCD) (36/157, 22.9%) and diffuse proliferative glomerulonephritis (DPGN) (26/157, 16.6%). Infection was present in 38/157 (24%) cases. Diffuse proliferative glomerulonephritis was the predominant type associated with streptococcal infection (52.9%) while Hepatitis B was seen in 83% of cases of membranous nephropathy.
  
  
  CONCLUSIONS
  Mesangial proliferative glomerulonephritis is the commonest histology seen in Jamaican children with atypical nephrotic syndrome. Most membranous nephropathy is Hepatitis B related. Hypertension with hypocomplementaemia, renal failure and anaemia are features of more serious renal disease (eg membranoproliferative glomerulonephritis and crescentic nephritis) rather than MCNS and should warrant urgent nephrology consultation for renal biopsy.
authors.affiliation: Department of Obstetrics, Gynaecology and Child Health, The University of the West Indies, Kingston 7, Jamaica, West Indies.
authors.forename: M
authors.initials: M
authors.lastname: Gooden
authors.forename: M
authors.initials: M
authors.lastname: Miller
authors.forename: D
authors.initials: D
authors.lastname: Shah
authors.forename: A K
authors.initials: AK
authors.lastname: Soyibo
authors.forename: J
authors.initials: J
authors.lastname: Williams
authors.forename: E N
authors.initials: EN
authors.lastname: Barton
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D015432:Glomerulonephritis, Membranoproliferative / Q000473:pathology; D015433:Glomerulonephritis, Membranous / Q000382:microbiology / Q000473:pathology; D006801:Humans; D007563:Jamaica; D007668:Kidney / Q000473:pathology*; D008297:Male; D009402:Nephrosis, Lipoid / Q000473:pathology; D009404:Nephrotic Syndrome / Q000473:pathology*; D013290:Streptococcal Infections / Q000473:pathology