Clinicopathological spectrum of pediatric renaldiseases: a single-center experience based on nativekidney biopsies
Abstract
Background: In pediatric renal disorders, the decision about further evaluation, the choice of treatment, and prognosis depends upon the histopathological pattern of injury. The study is done to characterize the indications and renal histopathological spectrum of kidney diseases among children who underwent kidney biopsy. Methods: This is a single-center, retrospective, cross-sectional study. The data of the Children aged ≤18 years who underwent a kidney biopsy in the Department of Nephrology from January 2022 to August 2024 were retrieved from the hospital records and analyzed. Results: Out of 601 biopsies, pediatric biopsies accounted for 61/601 (10.1%) of all biopsies. The most common indication for kidney biopsy was nephrotic syndrome, present in 39/61 (63.9%), followed by nephritic syndrome and asymptomatic urinary abnormality, present in 9/61 (14.8%), and 5/61 (8.2%), respectively. The most common renal histopathological lesion was minimal change disease in 18/61 (29.5%), followed by focal segmental glomerulosclerosis (FSGS) and IgA (Immunoglobin A) nephropathy present in 12/61 (19.7%) and 8/61 (13.1%), respectively. Minimal change disease, FSGS, and IgA nephropathy accounted for 18/39 (46.2%), 10/39 (25.6%), and 5/39 (12.8%) of all cases of nephrotic syndrome. IgA and lupus nephritis each accounted for 3/9 (33.3%) of nephritic syndrome patients. FSGS NOS (Not otherwise specified) variant accounted for 10/12 (83.3%) of FSGS cases. Diffuse foot process effacement was observed in 66.7% of FSGS cases, with 10/12 (83.3%) presenting with nephrotic syndrome. Among IgA with a nephrotic presentation, 60% showed diffuse foot process effacement. Conclusions: In pediatric nephrology, nephrotic syndrome stands as the leading indication for kidney biopsy, with minimal change disease, FSGS, and IgA nephropathy comprising the majority of diagnoses. Electron microscopy is a crucial diagnostic tool, particularly in differentiating primary podocytopathies.
Keywords
How to Cite
References
[1] Hogan JJ, Mocanu M, Berns JS. The native kidney biopsy: update and evidence for best practice. Clinical Journal of the American Society of Nephrology. 2016; 11: 354–362.
[2] Terano C, Hamada R, Tatsuno I, Hamasaki Y, Araki Y, Gotoh Y, et al.; Japanese Study Group of Renal Disease in Children. Epidemiology of biopsy-proven Henoch-Schönlein purpura nephritis in children: a nationwide survey in Japan. PLOS ONE. 2022; 17: e0270796.
[3] Sousa P, Brás C, Menezes C, Vizcaino R, Costa T, Faria MS, et al. Percutaneous kidney biopsies in children: a 24-year review in a tertiary center in northern Portugal. Brazilian Journal of Nephrology. 2024; 46: e20230143.
[4] Rafique Z, Sadaf S, Batool S, Javeed S, Chughtai AS, Atiq A. Morphological spectrum of glomerulonephritis in medical renal biopsies: a single-center study. Cureus. 2022; 14: e22579.
[5] Wang Y, Zhang L, Yuan L, Xie Q, Liu S, Hao CM. Changes in the spectrum of biopsy-proven renal diseases over 11 years: a single-center study in China. Renal Failure. 2024; 46: 2381614.
[6] Huang G, Liu F, Yu L, Wang J, Chen J, Mao J. Pediatric membranous nephropathy: in the novel antigens era. Frontiers in Immunology. 2022; 13: 962502.
[7] Agarwal SK, Sethi S, Dinda AK. Basics of kidney biopsy: a nephrologist’s perspective. Indian Journal of Nephrology. 2013; 23: 243–252.
[8] Markowitz GS, D’Agati VD. The ISN/RPS 2003 classification of lupus nephritis: an assessment at 3 years. Kidney International. 2007; 71: 491–495.
[9] Yadav S, Kandalkar B. Epidemiology of pediatric renal diseases and its histopathological spectrum—a single-center experience from India. Saudi Journal of Kidney Diseases and Transplantation. 2021; 32: 1744–1753.
[10] Imtiaz S, Nasir K, Drohlia MF, Salman B, Ahmad A. Frequency of kidney diseases and clinical indications of pediatric renal biopsy: a single center experience. Indian Journal of Nephrology. 2016; 26: 199–205.
[11] Mohapatra A, Kakde S, Annapandian VM, Valson AT, Duhli N, Korula A, et al. Spectrum of biopsy proven renal disease in South Asian children: two decades at a tropical tertiary care centre. Nephrology. 2018; 23: 1013–1022.
[12] Ganesh K, Nair RR, Seethalekshmy NV, Kurian G, Mathew A, Sreedharan S, et al. A study of clinical presentation and correlative histopathological patterns in renal parenchymal disease. Indian Journal of Nephrology. 2018; 28: 28–34.
[13] Hu R, Quan S, Wang Y, Zhou Y, Zhang Y, Liu L, et al. Spectrum of biopsy proven renal diseases in central China: a 10-year retrospective study based on 34,630 cases. Scientific Reports. 2020; 10: 10994.
[14] Alhasan K, Aloudah NM, Bakhit AA, Alhamad YM, Chihabeddine KM, Alfaadhel TA, et al. Renal histopathology spectrum in children with kidney diseases in Saudi Arabia, 1998–2017. Saudi Medical Journal. 2020; 41: 369–375.
[15] Al Battashi M, Al Nadhairi Z, Al Riyami A, Al Gaithi B, Al Maskari A, Al Saidi S, et al. Pediatric kidney biopsies in Oman: a retrospective study. Oman Medical Journal. 2023; 38: e503.
[16] Abdelraheem MB, Ali TM, Mohamed RM, Hassan EG, Abdalla OA, Mekki SO, et al. Pattern of glomerular diseases in Sudanese children: a clinicopathological study. Saudi Journal of Kidney Diseases and Transplantation. 2010; 21: 778–783.
[17] Safdar RS, Mehar MF, Khan AA, Buzdar N. Focal segmental glomerulosclerosis in paediatric population of south Punjab Pakistan: a tertiary care hospital experience. Pakistan Journal of Medical Sciences. 2021; 37: 510–514.
[18] Lee SA, Kim MS, Kim SC, Lee DY. Clinical and pathological findings of renal biopsy in children: outcomes from a single center over 27 years. Childhood Kidney Diseases. 2017; 21: 8–14.
[19] Zahir Z, Wani AS, Jain M, Agrawal V, Jain S. Pediatric glomerular diseases in north India—epidemiology and clinicopathologic correlation. Indian Journal of Nephrology. 2023; 33: 28–34.
[20] Sun M, Wang L, Liu X, Xiao F, Dai H. The successful use of rituximab in IgA nephropathy patients with podocytopathy: a case series. Clinical Kidney Journal. 2024; 17: sfae178.
[21] Khatri S, Bajeer IA, Aziz M, Mubarak M, Lanewala AA, Hashmi S. Insights into pediatric lupus nephritis: clinical features and short-term outcomes from a single center retrospective study. BMC Nephrology. 2025; 26: 145.
[22] Chan EY, Marks SD. Childhood-onset lupus nephritis: unique aspects and challenges in management. Kidney International. 2025; 108: 799–810.
[23] Chan EY, Boyer O. Childhood idiopathic nephrotic syndrome: recent advancements shaping future guidelines. Pediatric Nephrology. 2025; 40: 2431–2442.
[24] Kari JA, Bockenhauer D, Stanescu H, Gari M, Kleta R, Singh AK. Consanguinity in Saudi Arabia: a unique opportunity for pediatric kidney research. American Journal of Kidney Diseases. 2014; 63: 304–310.
[25] Sethi S. New ‘Antigens’ in membranous nephropathy. Journal of the American Society of Nephrology. 2021; 32: 268–278.
[26] Andeen NK, Kung VL, Robertson J, Gurley SB, Avasare RS, Sitaraman S. Fibrillary glomerulonephritis, DNAJB9, and the unfolded protein response. Glomerular Diseases. 2022; 2: 164–175.
Copyright and licence
Copyright (c) 2026 Amir Farooq, Nucksheeba Aziz Bhat, Mehraj Ul Islam Teeli, Rayees Yousuf, Manzoor Ahmad Parry, Muzamil Ahmad Wani, Imran Khan, Imtiyaz Wani, Muzafar Maqsood Wani
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
