PEDIATRICS Vol. 30 No. 3 September 1962, pp. 477-496
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PERCUTANEOUS RENAL BIOPSY IN CHILDREN

IV. The Collagen Diseases, Juvenile Diabetes Mellitus, and Idiopathic Hematuria and Proteinuria

W. F. Dodge M.D.1, C. W. Daeschner Jr. M.D.1, J. C. Brennan M.B., M.B.Ch.1, H. S. Rosenberg M.D.1, L. B. Travis M.D.1, and H. C. Hopps M.D.1

1 Departments of Pediatrics (Division of Renology and Metabolism) and Pathology, University of Texas Medical Center, Galveston, Texas; William Scott McFarland Memorial Pediatric Renal and Metabolic Research Laboratory, John Sealy Hospital, Galveston, Texas; and the Departments of Pediatrics and Pathology, University of Baylor College of Medicine, Houston, Texas

Eleven children with various collagen disorders were studied by renal biopsy. Generalized diffuse glomenular histologic changes were found in the children with Kunkel's syndrome (two), dermatomyositis (two), and unclassified collagen diseases (three). In addition, numerous plasma and mononuclear cells were noted about affected glomeruli in one of the children with Kunkel's syndrome. Normal renal histology was found in the biopsy specimens from two children with systemic lupus erythematosus. One of these two was found to have renal involvement at the time of a repeat examination 6 months later, at a time when a concentrated urinalysis still showed no abnormality. The remaining two children with systemic lupus were found to have generalized focal glomerular histologic changes.

Although some of the collagen diseases are classified into syndromes according to the organ or organ system principally involved, they all appear to be systemic illnesses, so it is not surprising that the glomerular capillaries showed changes from normal in each of these diseases studied. The renal lesion was accompanied by abnormal urinary findings in some patients, particularly those with the more marked histologic changes, but was also noted in patients who had no abnormal urinary findings.

Eight children with juvenile diabetes mellitus were studied by kidney biopsy. Six of these had a relatively poor level of clinical control, one was studied in the first month of his disease and one had a relatively good level of clinical control. All eight were found to have renal histopathologic changes. Our data neither confirm nor refute the finding in adult diabetics that there is a correlation between degree of histologic change and duration of diabetes but lack of correlation with level of control.

Antibodies to insulin have been reported by some investigators to be present in association with retinopathy and clinical nephropathy and have been suggested by others to be intimately related to the development of diabetic nephropathy. Three of eight children with juvenile diabetes were studied for presence of serum antibodies to crystalline insulin. Such antibodies were found in only one.

The presence of persistent hematuria and /or proteinuria, even in the absence of other clinical and laboratory findings, has in our experience usually indicated the presence of chronic glomerulonephritis. However, we have studied two children with persistent hematuria, three with persistent postural proteinuria, and one with persistent proteinuria, in both the upright and supine positions, in whom the renal histologic changes are so minimal as to make one wonder if they are significant.

It is possible that the two children with persistent hematuria are the first members of their respective families to have "familial nephritis" and that the children with persistent proteinuria represent early cases of "chronic glomerulonephritis." However, our data and those of other investigators do not allow us to speculate further at this point. It seems to us that the answer to these questions will come only from the further study of these and similar children by means of serial renal biopsies.