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http://dx.doi.org/10.3339/jkspn.2010.14.2.154

Clinicopathologic Changes of IgA Nephropathy in Children During Long-term (average 10.8 yrs) Follow-up  

Moon, Chang-Min (Department of Pediatrics, Kwandong University, College of Medicine)
Kim, Pyung-Kil (Department of Pediatrics, Kwandong University, College of Medicine)
Lim, Beom-Jin (Department of Pathology, Yonsei University, College of Medicine)
Song, Ji-Sun (Department of Pathology, Kwandong University, College of Medicine)
Jeong, Hyeon-Joo (Department of Pathology, Yonsei University, College of Medicine)
Publication Information
Childhood Kidney Diseases / v.14, no.2, 2010 , pp. 154-165 More about this Journal
Abstract
Purpose : We know little about the natural course of IgA nephropathy (IgAN) in association with histologic changes especially in children. We investigated clinicopathologic features with long-term follow-up biopsy to clarify the outcomes and prognostic indicators for childhood IgAN. Methods : From our patients' medical records, we retrieved 20 patients with IgAN, to whom renal biopsies had been performed for the initial diagnosis and follow-up to find out any histologic changes. Initial and follow-up biopsies were classified by Haas classification. The changes of these parameters were compared with the evolution of clinical features. Results : Patients were treated with angiotensin-converting enzyme inhibitors in combination with angiotensin receptor blockers (in subclass II or above) and short-term cyclosporine A(in patients showing nephrotic syndrome). Histologic improvement in 7 cases and deterioration in 3 cases were observed. At the time of last biopsy, 10 cases (50%) showed clinical remission and the others showed improved clinical features. These clinical outcomes did not correlate with initial Haas classifications. Hypertension at onset observed in 5 cases (25%) revealed significant correlation with clinical outcome (P =0.01) and last Haas classification (P =0.007). None of the cases showed progression to CRF or ESRD. Conclusion : During a mean follow-up of $10.8{\pm}3.4$ years, childhood IgAN showed good clinicopathologic outcome. Hypertension at onset was only a strong predictor of clinicopathologic outcomes, but initial Haas classification cannot predict outcomes in children. Histologic change of IgAN in long term follow-up period cannot be completely predicted by clinical data and vice versa. Therefore, a renal biopsy should be considered as a part of follow-up plan.
Keywords
IgA nephropathy; Children; Haas classification; Prognosis;
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