Q. A three year old male child presents with history of periorbital puffiness of seven days duration. The
swelling gradually increased to involve the whole body. There is history of decrease in urine output but no history of hematuria, dysuria. Examination reveals HR-106/min, RR-28/min, BP-100/74mmHg, and afebrile. There was generalised anasarca. CBC was normal, BUN and creatinine was normal. Urine examination revealed 4+ proteinuria. 3-4 RBC/HPF without any casts. C3 levels were normal.

The most likely feature in histopathology is

a)Minimal change disease
b)Focal segmental glomerulosclerosis
c)Membranous glomerulopathy
d)Membranoproliferative glomerulonephritis type 1
e)Membranoproliferative glomerulonephritis type 2

Answer; a
Explanation:
90% of children with nephrotic syndrome have idiopathic nephrotic syndrome. Of these minimal change disease (MCD) constitute 85% of cases. MCD most commonly occurs in preschool age group. Absence of hypertension, hematuria, hypocomplementemia and azotemia differentiates it from other classes.

Response to steroids is good and immunoflourescence staining is negative.

The only other close differential at this age is focal segmental glomerulosclerosis (FSGS). However many patients with FSGS have hypertension, hematuria, hypocomplementemia and azotemia. Response to steroids is poor.

Membranous glomerulopathy is uncommon in this age group and is usually secondary.

Membranoproliferative glomerulonephritis (MPGN} is present in age group 5-15 years and usually has hematuria as the predominant feature. Hypocomplementemia is common.