Spectrum of renal biopsy findings in pediatric renal diseases at a tertiary care hospital, Nepal

Abstract

Introduction: Renal biopsy is an important investigation in pediatric nephrology, as it helps in establishing a definite diagnosis when clinical features and laboratory findings are inconclusive. It plays a key role in guiding treatment decisions and predicting outcomes in children with kidney diseases. Renal biopsy findings differ between populations, but data in Nepali children are limited. This study describes biopsy indications and findings in children at a tertiary care hospital.

Method: Ethical approval was obtained from the Institutional Review Committee of Patan Academy of Health Sciences (IRC-PAHS). This prospective study was conducted from 5 February 2020 to May 2024. Data were collected using a structured proforma from children fulfilling the inclusion criteria and undergoing renal biopsy. Clinical indications for biopsy were recorded and compared with the corresponding histopathological diagnoses using descriptive analysis.

Result: Among 49 children undergoing renal biopsy (26 males; age 0-14 years), the main indications were lupus nephritis 15(30.6%), suspected rapidly progressive glomerulonephritis 13(26.5%), and steroid resistant nephrotic syndrome 9(18.4%). Histopathology showed lupus nephritis most frequently 15(33.3%), followed by minimal change nephrotic syndrome 9(20%), diffuse proliferative glomerulonephritis and Immunoglobulin A nephropathy each 6 (13.3%). Henoch-Schönlein purpura nephritis 4(8.9%).

Conclusion: Lupus nephritis was the most frequent indication and finding in pediatric renal biopsies, followed by rapidly progressive glomerulonephritis and nephrotic syndrome. Renal biopsy remains crucial for accurate diagnosis and optimal management of pediatric kidney diseases in tertiary care.