Pattern of Glomerular Disease in Patients with Nephrotic Syndrome-A Single Centre South Indian Study

Background: The prevalence of primary and secondary glomerular diseases presenting as nephrotic syndrome (NS) varies according to the demography, renal biopsy practice and geographic location. To determine the morphological patterns of glomerular lesions in renal biopsies from patients manifesting with NS, in our local (South Indian) population. Methods: The study was conducted in a tertiary care hospital in South India between 2008 and 2014 on adults and children presenting with NS. Renal biopsies were performed in all patients and subjected to light microscopic and immunofluorescence studies. Results: A total of 264 cases of NS were identified of which 80.7% were adults and 19.3% were children. The mean age for the adults was 42.2 years with a male: female ratio of 1.6:1 and the mean age for children was 12.1 with a male: female ratio of 1.8:1. The most common cause of NS in adults was minimal change disease (MCD) (42.7%) followed by membranous nephropathy (MN) (24.4%) and focal segmental glomerulo-sclerosis (FSGS) (17.8%). In children MCD (88%) was the single most common cause of NS followed by FSGS (5.9%) and MN (3.9%). Compared to MCD and MN, a higher incidence of microscopic haematuria and renal insufficiency was present in FSGS. Conclusion: A wide range of primary and secondary glomerular disorders can present as NS, the prevalence of which varies according to the geographic area and demography. Though the frequencies of MCD, MN, and FSGS in our study were different from other studies conducted in India and other countries, these three glomerular disorders are the three major causes of NS in many geographic areas across the world.