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 microscopyGeneralized 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: ReviewMost 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 : InsiduousClinical featuresPeripheral Edema: Presenting FeatureNephrotic syndrome is the typical presentationPeripheral edema is the hallmark of Nephrotic syndrome occurring when serum albumin levels become less than 3g/dlInitially dependent Edema > Generalized edema May develop Pleural effusion, pulmonary edema, ascitisHematuria : 20-30%Hypeension : V. RareRenal failure : Does not usually progress to renal failureLaboratory (Features of Nephrotic syndrome)ProteinuriaHypoalbuminemiaHyperlipidemia/Hyper cholesterolemia (Increased hepatic prduction of lipids)HypercoagulabilityRenal pathology (Biopsy)InvestigationLight microscopy QElectron microscopy QImmunofluorescence QObservationNo abnormality hence the term minimal changeFusion of foot processesAbsence of immunoglobulin or complementPrognosisPrognosis is GoodResponse to steroids is ExcellentDoes not progress to Renal FailureTreatmentsCoicosteroids 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