A 7 year old boy presented with generalized edema. Urine examination revealed marked albuminuria. Serum biochemical examinations showed hypoalbuminaemia with hyperlipidemia. Kidney biopsy was undeaken. On light microscopic examination, the kidney appeared normal. Electron microscopic examination is most likely to reveal
Answer is A (Fusion of foot processes of the glomerular epithelial cells): The presence of generalized edema is a 7 year old boy with proteinuria suggests a diagnosis of Nephrotic syndrome. This child is likely to have. Minimal change disease as this is the most common cause of Nephrotic syndrome in children and is associated with normal findings on Light microscopy Generalized edema May develop Pleural effusion, pulmonary edema, ascitis Patients with minimal change disease characteristically show fusion of foot processes of the glomerular epethelial cells on electron microscopy. Minimal change Disease: Review Most common cause of Nephrotic syndrome in children (80% in children; 20% in adults) Peak Age of onset is between 6-8 years of Age (usually < 10 years) Type of onset : Insiduous Clinical features Peripheral Edema: Presenting Feature Nephrotic syndrome is the typical presentation Peripheral edema is the hallmark of Nephrotic syndrome occurring when serum albumin levels become less than 3g/dl Initially dependent Edema > Generalized edema May develop Pleural effusion, pulmonary edema, ascitis Hematuria : 20-30% Hypeension : V. Rare Renal failure : Does not usually progress to renal failure Laboratory (Features of Nephrotic syndrome) Proteinuria Hypoalbuminemia Hyperlipidemia/Hyper cholesterolemia (Increased hepatic prduction of lipids) Hypercoagulability Renal pathology (Biopsy) Investigation Light microscopy Q Electron microscopy Q Immunofluorescence Q Observation No abnormality hence the term minimal change Fusion of foot processes Absence of immunoglobulin or complement Prognosis Prognosis is Good Response to steroids is Excellent Does not progress to Renal Failure Treatments Coicosteroids form the mainstay for treatment of MCD
Fusion of foot processes of the glomerular epithelial cells
Rarefaction of glomerular basement membrane
Deposition of electron dense material in the basement membrane
Thin basement membrane