15 yrs old Male, Surendra Upwanshi
r/o Bitoli , Balaghat (mp) admitted on 7/2/14 with c/o
Swelling over face and lower limbs since 15 days
Decreased urine out put since 10 days
No h/o fever, sore throat, skin infection, rash, joint pain
No h/o Jaundice / hemoptysis
No h/o DM
Inj Cefotaxime 0.5 gm tds
Inj lasix 80 mg bd
Tab cilnidepine 20 mg tds
Tab prazocin 5 mg od
Tab calcium lactate 1 tds
Tab atorvaststin 10 mg
Inj Methylprednisolone 750
mg od 3 day
Tab prednisolone 50 mg
Microscopy : -
Glomeruli are enlarged in size and shows diffuse segmental areas of
increase in mesangial matrix and hypercellularity and occasional
Focal areas of endocapillary hypercellularity are noted.
Focal areas of glomerular basement membrane thickening are noted.
Lobular accentuation is noted in 05 – 06 glomeruli.
Silver stain shows tram tracking.
The interstitium show mild mononuclear cell inflammatory infiltrate.
The blood vessels are unremarkable.
IgG : Positive (++) coarsely granular diffuse
mesangial deposits are seen.
IgM : Negative
IgA : Negative
C3 : Positive (++) coarsely granular diffuse
mesangial deposits are seen.
Impression :- Membranoproliferative
Glomerulonephritis with IgG and C3 positivity.
Nephrotic syndrome is a clinical complex characterized by a number
of renal and extrarenal features, most prominent of which are
(in practice > 3.0 to 3.5gm/24hrs),
Nephrotic syndrome can be
Primary, being a disease specific to the kidneys,
Secondary, being a renal manifestation of a systemic
Primary causes include-
Minimal-change nephropathy(70-90% in children and 10-
15% in adult)
Focal glomerulosclerosis (15% in adult)
Membranous nephropathy (30% in adult)
Membranoproliferative glomerulonephritis .
Diagnostic studies for nephrotic syndrome may include the
Urine sediment examination
Urinary protein measurement (24-hr)
Serologic studies for infection and immune abnormalities
2 biopsy cylinders
• minimal length 1 cm
• diameter 1.2 mm
# isotonic saline – fast local transport
• cryopreservation of one piece for immunefluorescence
• fixation with paraformaldehyde or buffered (4%)
formaldehyde for paraffin embedding
• fixation with 3% glutaraldehyde for electron microscopy
# direct fixation with paraformaldehyde or formaldehyde and
shipping (indirect immunehistology by APAAP (alkaline
phosphatase) or others
Uncorrectable bleeding diathesis
Uncontrollable severe hypertension
Active renal or perirenal infection
Skin infection at biopsy site
Anatomic abnormalities of the kidney which may increase risk
Bleeding- may occur in 3 distinct locations
Collecting system -blood is seen in the urine,Obstuction
Under the renal capsule-cause increase in the release of renin-hypertension
Into the perinephric space-Hematoma
The injured kidney can also undergo fibrosis-chronic hypertension
and perhaps even renal failure can result if the contralateral kidney is
compromised – “page kidney effect”