The nephrotic syndrome of infancy

A clinicopathologic study of forty-eight infants with nephrotic syndrome

The clinical and histopathologic features of 48 children presenting with the nephrotic syndrome during the first year of life were analyzed. Proteinuria was discovered soon after birth to 3 months of age in 39 infants (congenital nephrotic syndrome), and nine infants had an infantile onset presenting between 4 and 12 months of age. Neither histologic parameters--microglomeruli, epithelial, or mesangial proliferation, focal segmental or global sclerosis, fibrinoid necrosis, or tubular microcysts--nor histologic classification--microcystic disease, mesangial proliferative glomerulonephritis, focal segmental glomerular sclerosis/hyalinosis-predicted the outcome. Rather, age at presentation was found to predict outcome: One of 39 infants with a congenital onset and seven of nine infants with an infantile onset underwent a complete remission (P less than 0.0001).

Congenital nephrotic syndrome: prenatal diagnosis and genetic counselling by estimation of aminotic-fluid and maternal serum alpha-fetoprotein

Nine families in which a previous child had had congenital nephrotic syndrome (C.N.) sought genetic counselling and possible antenatal diagnosis of fetal disease. Maternal serum and amniotic-fluid alpha-fetoprotein (A.F.P.) assays were carried out between the 15th and 20th weeks of subsequent pregnancies. Seven women in whom A.F.P. concentrations were normal chose to continue pregnancy, and they were all delivered of a healthy child. Markedly raised amniotic A.F.P. concentrations were found in two cases; in one of these cases maternal serum-A.F.P. was also raised. These pregnancies were terminated, and electron microscopy of the fetal kidneys showed evidence of C.N. in the fetus--i.e., loss of foot processes and an increase in the mesangial matrix of the glomeruli. The outcomes of these at-risk pregnancies indicate that prenatal diagnosis and genetic counselling are possible in families with a history of C.N. The results also stress the importance of carefully examining fetal kidneys whenever amniotic-fluid A.F.P. concentration is raised in the absence of apparent malformations.