The nephrotic syndrome of childhood: immunologic, clinical, and pathologic correlations.

Abstract

Renal tissue was obtained from 35 children with nephrotic syndrome and was studied by the immuno-fluorescent technique for immunoglobulin G (IgG) and beta1C (B1C) globulin deposition; findings were correlated with light microscopic changes and with the clinical course. Patients were divided into 3 groups on the basis of the immunofluorescent findings. Group I comprised 22 children with no glomerular IgG or B1C deposition; most of these had minimal renal pathology and responded to steroid therapy with complete clearing of proteinuria. Group II comprised 7 patients, clinically and pathologically indistinguishable from Group I, who showed a coarse focal type of glomerular IgG and B1C deposition. These deposits were not extensive and although the exact localization was not established the basement membranes were not involved. Group III was 6 patients who showed marked glomerular basement deposition of IgG and B1C; pathologic changes in this group included subacute, chronic and membranous glomerulonephritis, and none of the patients responded to steroid therapy. It is concluded that immunologic mechanisms of the type known to be associated with the patho-genesis of renal disease are probably not operative in most children with the nephrotic syndrome. Immunologic processes appear to be operative in some of the nephrotic children whose clinical course and kidney lesions are indicative of severe glomerular injury.