Histopathological Patterns of Nephrotic Syndrome in a Tertiary Care Center in Ile-Ife, Southwestern Nigeria: A 16-Year Retrospective Study

Background: Nephrotic syndrome is one of the major ways in which kidney disease presents clinically the world over. Where biopsies are carried out, the microscopic appearances observed in the affected patients vary according to age, gender, race and geographical location. In most cases, the vital information obtained from the histological assessment of these patients is pivotal to instituting effective management of their diseases.

In this study, we set out to describe the spectrum of microscopic findings in renal biopsies obtained from nephrotic syndrome patients in our hospital between January 2002 to December 2017.

Methodology: Archival formalin-fixed-paraffin-embedded renal biopsy tissue blocks were subjected to routine Heamatoxylin & Eosin(H&E), Jones Methelamine Silver (JMS), Masson’s Trichrome (MT) and Periodic Acid Schiff stains (PAS) as well as immunoperoxidase stains for IgG, IgM, IgA and C3. The slides were viewed using binocular light microscope.

Results: A total of 73 cases were reviewed with a male to female ratio of 1.7:1 and mean age of 20.2 years SD of 11.6). Overall, focal segmental glomerulosclerosis (FSGS) (48.3%) was the most frequent histological pattern observed. FSGS and minimal change disease were the commonest histological patterns seen in children while FSGS and membranous glomerulopathy were the most common patterns in adult population. There were four cases of IgA nephropathy on immunoperoxidase stain. The previous diagnosis was changed in 13 cases, with use of immunostaining which was not carried out ab initio.

Conclusion: This study shows that FSGS is the most common histopathological finding among patients with the nephrotic syndrome in our hospital irrespective of age or gender. In addition, we found that the use of immunoperoxidase in assessment of renal biopsy is important in making a more accurate and clinically relevant diagnosis.