Title:
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The quantitative histological assessment of the pathological changes found in renal biopsy specimens from children : a clinico-pathological study
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Evaluation of the histological changes found in
kidney biopsies taken during the investigation of children ,
with renal disease is complicated by the fact that in many
instances the abnormalities seen by light microscopy are slight
or absent, and may be prone to subjective errors of
interpretation. In this thesis a number of renal biopsy
specimens have been studied from 106 children presenting with
a nephrotic syndrome, with idiopathic recurrent haematuria or
with evidence. of renal involvement in anaphylactoid purpura.
In addition to a morphological classification, more objective
histological techniques have been applied in analysing the
changes found. Semi-quantitative methods of assessing the
over-all degree of glomerular and tubular damage present have
been used, and in addition, differential counts of the various types of cell composing the renal glomeruli have been made.
These counts were found to be particularly, valuable in the interpretation of slight degrees of 'proliferative' change in the renal glomeruli, the presence or absence of which is often
difficult to establish subjectively. A number of preliminary
studies were made to establish the reproducibility of the techniques of histological assessment used, and the renal biopsy
findings were correlated with various clinical data.
In children presenting with a nephrotic syndrome the
histological findings were correlated both with the response to treatment, and where appropriate, with the clinical outcome.
Amongst the children with nephritis following anaphylactoid
purpura, a very good correlation was found between the degree
of ✓structural damage revealed on renal biopsy and the subsequent clinical course. In these biopsy specimens, and also
in those taken from children presenting with idiopathic recurrent
haematuria in which proliferative changes were found in the
renal glomeruli, differential glomerular cell counts showed that in the majority of cases proliferative changes were diffuse
rather than focal in distribution, affecting all the glomeruli
present. In patients with idiopathic recurrent haematuria,
renal biopsies were histologically normal in many instances.
A very close correlation was found between the amount of protein excreted in the urine by these children and the presence of abnormalities on renal biopsy.
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