Browse > Article

Clinicopathologic features and prognosis of childhood IgA nephropathy  

Woo, Sung Il (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine)
Bae, Keun Wook (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine)
Lee, Joo Hoon (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine)
Park, Young Seo (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine)
Cho, Yong Mee (Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine)
Publication Information
Clinical and Experimental Pediatrics / v.50, no.2, 2007 , pp. 170-177 More about this Journal
Abstract
Purpose : Clinicopathological features were investigated to clarify the outcome and prognostic indicators for patients with IgA nephropathy in Korean children. Methods : We reviewed the outcomes of 61 patients in whom IgA nephropathy was diagnosed before the age of 15 years from 1991 to 2005 and followed-up at least for one year. All patients were confirmed by renal biopsy. Results : After mean follow-up of 5.2 years from onset, 24 patients of 61 (39.3%) were in clinical remission at the last examination. Thirty patients (49.2%) had hematuria or mild proteinuria (<$1g/m^2/d$), five (8.2%) had severe proteinuria (${\geq}1g/m^2/d$), and two (3.3%) had chronic renal failure. By univariate analysis, initial presentation at onset and Haas classification were less concordant with outcome. Hypertension during follow-up, rather than hypertension at presentation, was significantly correlated with outcomes (P<0.01). Sixty percent of patients who had more than 20% of glomerular sclerosis or crescent progressed to severe proteinuria or chronic renal failure, as compared with 7.1% of those who did not (P<0.01). Conclusion : Prognosis of childhood IgA nephropathy had a relatively benign course during a mean follow-up of 5.2 years. Persistent hypertension during follow-up and more than 20% of glomerular sclerosis or crescent were strong predictors of a progressive course of IgA nephropathy. A new histologic classification according to characteristics of childhood IgA nephropathy must be established to assess prognosis. Further efforts should be made to understand the prognosis of IgA nephropathy through long-term follow-up.
Keywords
Glomerulonephritis; IGA; Children; Prognosis;
Citations & Related Records
연도 인용수 순위
  • Reference
1 DAmico G. The commonest glomerulonephritis in the world: IgA nephropathy. Q J Med 1987;64:709-27
2 DAmico G. Natural history of IgA nephropathy and factors predictive of disease outcome. Semin Nephrol, 2004;24:179-96   DOI   ScienceOn
3 Lee JK. Standard blood pressure of child and adolescent in 2005. Program and Abstract, 56th Annual Spring Meeting of The Korean Pediatric Society; 2006 Apr 28-29; Yong- Pyung, Seoul : The Korean Pediatric Society 2006:63-90
4 Utsunomiya Y, Kado T, Koda T, Okada S, Hayashi A. Fukuwaza A, et al. Features of IgA nephropathy in preschool children. Clin Nephrol 2000;54:443-8
5 Park YH, Choi JY, Chung HS, Koo JW, Kim SY, Namgoong MK, et al. Hematuria and proteinuria in a mass school screening test. Pediatr Nephrol 2005;20:1126-30   DOI
6 Lee JS, Kwon JH, Choi EN, Park JM, Jeung HJ. A clinicopathologic study on the prognosis of IgA nephropathy in children. J Korean Soc Pediatr Nephrol 2003:7;23-9
7 Andreoli SP, Yum MN, Bergstein JM. IgA nephropathy in children : significance of glomerular base membrane deposition of IgA. Am J Nephrol 1986;6:28-33   DOI
8 Delos Santos NM, Wyatt RJ. Pediatric IgA nephropathy: clinical aspects and therapeutic approaches. Semin Nephrol 2004:24;269-86   DOI   ScienceOn
9 Holt RCL, Connell JE, Addison GM. Reference data for pediatric nephrology. In : Webb NJA, Postlethwaite RJ. Clinical pediatric nephrology. 3rd edition. Oxford : Oxford University Press 2003:493-509
10 Ikezumi Y, Suzuki T, Imai N, Ueno M, Narita I, Kawachi H, et al. Histologic difference in newly onset IgA nephropathy between children and adults. Nephrol Dial Transplant 2006:1-9
11 Nolin L, Courteau M. Management of IgA nephropathy: evidence-based recommendation. Kidney Int 1999;70:s62-9
12 Hebert LE, Wilmer WA, Falkenhain ME, Ladson-Wofford SE. Nahman NS Jr, Robin BH. Renoprotection: one or many therapies? Kidney Int 2001;59:1211-23   DOI   ScienceOn
13 Shigematsu H, Ito N, Ishigame H, Ehara T, Kato M, Washizawa K, et al. Age-related character of glomerular lesions in IgA nephritis(2). Histopathological peculiarity in childhood onset. Nippon Jinxo Gakkai Shi 1992;34:33-9
14 Berger J, Hinglais N. Intercapillary deposits of IgA-G. J Urol Nephrol 1968;74;694-5
15 Maschio G, Gagnoli L, Claroni F, Fusaroli M, Ruqiu C, Sanna G, et al. ACE inhibition reduces proteinuira in normotensive patients with IgA nephropathy: A multicenter, randomizd, placebo-controlled study. Nephol Dial Transplant 1994;9:265-9
16 Hogg RJ, Silva FG, Wyatt RJ, Reisch JS, Argyle JE, Savino DA. Prognostic indicators in children with IgA nephropathy: Report of the Southwest Pediatric Nephrology Study Group. Pediatr Nephrol 1994;8:15-20   DOI
17 Hogg RJ, Wyatt RJ. Scientific Planning Committee of the North American IgA Nephropathy Study. A randomized controlled trial of mycophenolate mofetil in patients with IgA nephropathy. BMC Nephrol 2004;5:3   DOI
18 Wyatt RJ, Kritchevsky SB, Woodford SY, Miller PM, Roy S 3rd, Holland NH, et al. IgA nephropathy: long-term prognosis for pediatric patients. J Pediatr 1995;127:913-9   DOI   ScienceOn
19 Ronkainen J, Ala-Houhala M, Autio-Harmainen H, Jahnukainen T, Koskimies O, Merenmies J, et al. Long-term outcome 19 years after childhood IgA nephritis: a retrospective cohort study. Pediatr Nephrol 2006;21:1266-73   DOI
20 Yoshikawa N, Tanaka R, Iijima K. Pathophysiology and treatment of IgA nephropathy in children. Pediatr Nephrol 2001;16:446-57   DOI
21 DAmico G. Imbasciati E, Barbiano Di Belgioioso G. Bertoli S. Bertoli S, Fogazzi G, et al. Idiopathic IgA mesangial nephropathy. Clinical and histological study of 374 patients. Medicine(Baltimore) 1985;64:49-60   DOI
22 Delos Santos NM, Ault BH, Gharavi AG, Kritchevsky SB, Quasney MW, Jackson EC, et al. Angiotensin-converting enzyme genotype and outcome in pediatric IgA nephropathy. Pediatr Nephrol 2002;17:496-502   DOI   ScienceOn
23 Yoshikawa N, Ito H, Yoshihara S, Nakagara C. Yoshiya K, Hasegawa O, et al. Clinical course of Immunoglobulin A nephropathy in children. J Pediatr 1987;110:555-60   DOI
24 Kusumoto Y. Takebayashi S. Taguchi T. Harada T. Naito S. Long-term prognosis and prognostic indices of IgA nephropathy in juvenile and in adult Japanese. Clin Nephrol 1987;28:118-24
25 Schwartz GJ, Brion LP, Spitzer A. The use of plasma creatinine concentration to estimate glomerular filtration rate in infancy, childhood, adolescence. Pediatr Clin North Am 1987:34;571-90   DOI
26 Haas M. Histologic subclass of IgA nephropathy: a clinicopathologic study of 244 cases. Am J Kidney Dis 1997;29: 829-42   DOI   ScienceOn
27 Yosikawa N. Immunoglobulin A nephropathy. In : Qvener ED, Harmon WE, Niadet P. Pediatric nephrology. 5th ed. Philadelphia : LW & Wilkins Co 2004:615-28
28 Yosikawa N, Iijima K, Ito H. IgA nephropathy in children. Nephron 1999;83:1-12   DOI   ScienceOn
29 Levi M, Gonzalez-Buschard G, Broyer M, Dommergues J, Foulard M, Sorez J, et al. Bergers disease in children. Natural history and outcome. Medicine(Baltimore) 1985;64: 157-80
30 Coppo R, DAmico G. Factors predicting progression of IgA nephropathies. J Nephrol 2005;18:503-127
31 Schwartz GJ, Haycock GB, Edelmann CM Jr, Spitzer A. A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 1976;58:259-63
32 Nozawa R, Suzuki J, Takahashi A, Isome M, Kawasaki Y, Suzuki S, et al. Clinicopathological features and the prognosis of IgA nephropathy in Japanese children on longterm observation. Clin Nephrol 2005:64;171-9   DOI
33 Coppo R. Chiesa M, Peruzzi L, Amore A. Treatment of IgA nephropathy with anigiotensin converting enzyme inhibiter: design of a prospective randomized multicenter trial. J Nephrol 2001:14;447-52
34 The Southwest Pediatric Nephrology Study Group. A multicenter study of IgA nephropathy in children. A report of the Southwest Pediatric Nephrology Study Group. Kidney Int 1982;22:643-52   DOI   ScienceOn
35 Ariceta G, Gallego N, Lopez.Fernandez Y, Lopez Fernandez Y, Vallo A, Quintela MJ, el al. Long.term prognosis of childhood IgA nephropathy in adult life. Med Clin(Brac) 2001;116:361-4   DOI   ScienceOn
36 Yoshikawa N, Ito H, Nakamura H. Prognostic indicators in childhood IgA nephropathy. Nephron 1992;60:60-7   DOI
37 Floege J. Evidence-based recommendation for immunosuppression in IgA nephropathy: handle with caution. Nephrol Dial Transplant 2003;18:241-5   DOI   ScienceOn
38 Bhattacharjee R, Filler G. Additive antiproteinuric effect of ACE inhibitor and losartan in IgA nephropathy. Pediatr Nephrol 2002;17:302-4   DOI   ScienceOn