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Mesangial hypercellularity in children: presenting features and outcomes

Douglas M Silverstein1, Randall D Craver

  • 1Department of Pediatrics, Louisiana State University Health Sciences Center and Children's Hospital New Orleans, New Orleans, LA 70118, USA. dsilvers@cnmc.org

Pediatric Nephrology (Berlin, Germany)
|March 8, 2008
PubMed

Insights

Mesangial hypercellularity (MH) in children shows a favorable prognosis, with stable blood pressure and kidney function. Foot-process fusion (FPF) is linked to nephrotic syndrome (NS) and relapses, while MH generally indicates a good outcome.

Area of Science:

  • Pediatric Nephrology
  • Renal Pathology
  • Glomerular Diseases

Background:

  • Mesangial hypercellularity (MH), without sclerosis or immune deposition, is a frequent renal biopsy finding.
  • This study focuses on 66 children diagnosed with predominant MH.

Purpose of the Study:

  • To evaluate the clinical course and prognostic factors in children with predominant mesangial hypercellularity.
  • To investigate the impact of specific pathological features like foot-process fusion (FPF) and matrix thickening on outcomes.

Main Methods:

  • Retrospective analysis of 66 pediatric patients with predominant MH on renal biopsy.
  • Assessment of clinical parameters including blood pressure (BP), glomerular filtration rate (GFR), serum albumin (Alb), and urine protein/creatinine ratio.
  • Correlation of pathological findings (FPF, matrix thickening, immunofluorescence) with clinical outcomes and treatment responses.

Main Results:

  • In children over 2.7 years, BP and GFR remained stable; serum albumin trended higher and urine protein/creatinine lower.
  • The proportion of patients with stage 1 chronic kidney disease (CKD) remained constant (94% start vs. 92% end).
  • Diffuse foot-process fusion (FPF) was associated with nephrotic syndrome (NS), frequent relapses, and steroid sensitivity (SS). Positive immunofluorescence (IF), particularly IgM alone, correlated with better steroid sensitivity and less need for alkylating agents (Alk).

Conclusions:

  • Mesangial hypercellularity (MH) in children, in the absence of significant sclerosis or immune deposition, generally predicts a favorable prognosis.
  • Foot-process fusion (FPF) is a significant predictor of nephrotic syndrome (NS) and recurrent disease, while matrix thickening may be associated with better treatment response.
  • MH appears to be a benign finding, but specific histological features like FPF warrant close monitoring for NS development and management.

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