ABSTRACT
Introduction: Childhood nephrotic syndrome has an incidence of 90–100 per million population of India. This study was conducted with the primary objective of studying the prevalence of different clinical variants of childhood nephrotic syndrome (new-onset steroid-sensitive nephrotic syndrome/infrequent relapsing nephrotic syndrome [IFRNS]/frequently relapsing nephrotic syndrome [FRNS]/steroid-dependent nephrotic syndrome [SDNS]/steroid-resistant nephrotic syndrome [SRNS]), while the secondary objectives were to estimate the prevalence of use of steroid-sparing drugs in those with FRNS and SDNS. Materials and Methods: A retrospective study of all patients referred to renal diseases clinic at Government Medical College, Jammu, was done. Records of 61 children of 1–18 years of age fulfilling the International Study of Kidney Disease in Children criteria for nephrotic syndrome attending to our nephrology clinic were reviewed over 1 year period. Standard definitions for new-onset nephrotic syndrome, IFRNS, FRNS, SDNS, and SRNS were used. Steroid-sparing drugs used were levamisole in FRNS and low-dose SDNS whereas cyclophosphamide, mycophenolate mofetil (MMF), and tacrolimus in high-dose SDNS. Results: Among nephrotic syndrome, patients mean age of presentation was 5.95 years, with M: F ratio of 1.77:1. Infrequent relapsers (27.9%) were the most prevalent clinical variant followed by steroid-dependent nephrotic syndrome (24.6%) and new-onset nephrotic syndrome (21.3%). Prednisolone alone was successful in achieving remission in 50.8% of total cases and less commonly involving use of other immunosuppressants with prednisolone such as levamisole (23%), cyclophosphamide (9.8%), and tacrolimus in (3.3%). However, prednisolone in combination with cyclophosphamide and then MMF was used in 14 (23%) in an aim to achieve full remission, but full remission was achieved in 48 (78.7%). Conclusion: In the present study, clinical profile of children with nephrotic syndrome was concordant with typical nephrotic syndrome in children. Pattern of nephrotic syndrome differs in our population in terms of increased number with SDNS and response to treatment did not differ significantly from other studies.
ABSTRACT
Background: The knowledge of the basic humanmorphology and developmental anatomy is very imperative for diagnostic and therapeutic procedures. The question of study of human renal development arose for prenatal diagnosis of congenital malformations. There are few reports regarding the morphological development of human kidney, So, our study aims at contributing to the knowledge of morphogenesis and histogenesis of human kidney. At various gestations. Materials andmethod: 30 human fetal kidneys between 10 to 34weeks of gestationwere dissected and processed in paraffin, 7mm thick sections were stained with Haematoxylin-Eosin and Masson’s Trichrome stains. They were divided into 5 groups according to CRL and light microscopy examination done. Results: Morphogenesis of human kidney starts at 5th week of gestation and extends upto last month of last trimester of pregnancy, renal pelvis was very small and undifferentiated at 10 weeks and fully differentiated at 18 weeks. Zone of transition between cortex and medulla appeared at the starting of 14 weeks, presence of lobulation in kidneys was observed as early as 10 weeks, lobules start fusing with each other at 15 weeks of gestation. An arcade system along with well-defined pyramids was observed at 16-18 weeks. Conclusion: The present work made an attempt to do detailed light microscopy of human kidney at various stages of gestation, the data on which is scanty in Indian population.