Springer Nature is making Coronavirus research free. View research | View latest news | Sign up for updates

Prognostic indicators in children with IgA nephropathy — Report of the Southwest Pediatric Nephrology Study Group

  • 121 Accesses

  • 83 Citations


Investigators in 13 pediatric nephrology centers reviewed clinical and pathological features in 218 children and adolescents with IgA nephropathy (IgAN), with particular emphasis on 80 patients who had follow-up periods of at least 4 years. Potential prognostic markers in the 80 children were compared between 12 (15%) who developed end-stage renal disease (ESRD) versus 68 who did not. The relationship between clinical and pathological features and the subsequent development of ESRD was examined using stepwise linear discriminant analysis in addition to standard univariate analysis. Seven variables were found to be predictive of ESRD: the presence of glomerular sclerotic changes, especially when this was associated with proliferation or sclerosis in 20% or more of the glomeruli, black race; hypertension at biopsy; proteinuria at biopsy; age at presentation; crescents; male sex. Using the resulting discriminant function, development of ESRD could be correctly predicted in 95% of the subjects. We conclude that ESRD is more common in American children with IgAN than was realized previously. Risk factors previously documented in adult studies have been confirmed, especially the presence of glomerular sclerosis, proteinuria, and hypertension.

This is a preview of subscription content, log in to check access.


  1. 1.

    Noel LH, Droz D, Gascon M, Berger J (1987) Primary IgA nephropathy: from the first-described cases to the present. Semin Nephrol 7:351–354

  2. 2.

    Neelakantappa K, Gallo GR, Baldwin DS (1987) Proteinuria in IgA nephropathy. Semin Nephrol 7:344–345

  3. 3.

    Velo M, Lozano L, Egido J, Gutierrez-Millet, Hernando L (1987) Natural history of IgA nephropathy in patients followed-up for more than ten years in Spain. Semin Nephrol 7:346–350

  4. 4.

    D'Amico G, Colasanti G, Barbiano di Belgioioso G, Fellin G, Ragni A, Egidi F, Radaelli L, Fogazzi G, Ponticelli C, Minetti L (1987) Long-term follow-up of IgA mesangial nephropathy: clinico-histological study in 374 patients. Semin Nephrol 7:355–358

  5. 5.

    Rambausek M, Rauterberg E-W, Waldherr R, Demaine A, Krupp G, Ritz E (1987) Evolution of IgA glomerulonephritis: relation to morphology, immunogenetics, and BP. Semin Nephrol 7:370–373

  6. 6.

    Clarkson AR, Woodroffe AJ, Aarons I (1987) IgA nephropathy in patients followed-up for at least ten years. Semin Nephrol 7:377–378

  7. 7.

    Magil AB, Ballon HS (1987) IgA nephropathy: evaluation of prognostic factors in patients with moderate disease. Nephron 47:246–252

  8. 8.

    Levy M, Beaufils H, Gubler MC, Habib R (1973) Idiopathic recurrent macroscopic hematuria and mesangial IgA-IgG deposits in children (Berger's disease). Clin Nephrol 1:63–69

  9. 9.

    Michalk D, Waldherr R, Seelig HP, Weber HP, Scharer K (1980) Idiopathic mesangial IgA-glomerulonephritis in childhood. Description of 19 pediatric cases and review of the literature. Eur J Pediatr 134:13–22

  10. 10.

    Southwest Pediatric Nephrology Study Group (1982) A multicenter study of IgA nephropathy in children. Kidney Int 22:643–652

  11. 11.

    Yoshikawa N, Matsuo T (1984) IgA nephropathy in children. Compr Ther 10:35–41

  12. 12.

    Kitajima T, Murakami M, Sakai O (1983) Clinicopathological features in the Japanese patients with IgA nephropathy. Jpn J Med 22: 219–222

  13. 13.

    Kher KK, Makker SP, Moorthy B (1983) IgA nephropathy (Berger's disease)— a clinicopathologic study in children. Int J Pediatr Nephrol 4:11–18

  14. 14.

    Taylor J, Risdon RA, Barratt TM, Dillon MJ (1989) Long term follow up of IgA nephropathy in children. Pediatr Nephrol 3:C155

  15. 15.

    Linné T, Berg U, Bohman S-O, Sigström L (1991) Course and long-term outcome of idiopathic IgA nephropathy in children. Pediatr Nephrol 5:383–386

  16. 16.

    Mina SN, Murphy WM (1985) IgA nephropathy: a comparative study of the clinicopathologic features in children and adults. Am J Clin Pathol 83:669–675

  17. 17.

    Wyatt RJ, Julian BA, Bhathena DB, Mitchell BL, Holland NH, Malluche HH (1984) IgA nephropathy: presentation, clinical course, and prognosis in children and adults. Am J Kidney Dis 4:192–200

  18. 18.

    Levy M, Gonzalez-Burchard G, Broyer M, Dommergues J-P, Foulard M, Sorez J-P, Habib R (1985) Berger's disease in children. Natural history and outcome. Medicine (Baltimore) 64:157–180

  19. 19.

    Hattori S, Karashima S, Furuse A, Terashima T, Hiramatsu M, Murakami M, Matsuda I (1985) Clincopathologic correlation of IgA nephropathy in children. Am J Nephrol 5:182–189

  20. 20.

    Yoshikawa N, Ito H, Yoshiara S, Nakahara C, Yoshiya K, Hasegawa O, Matsuo T (1987) Clinical course of immunoglobulin A nephropathy in children. J Pediatr 110:555–560

  21. 21.

    Kusumoto Y, Takebayashi S, Taguchi T, Harada T, Naito S (1987) Long-term prognosis and prognostic indices of IgA nephropathy in juvenile and in adult Japanese. Clin Nephrol 3:118–124

  22. 22.

    Hattori M, Tokuyama M, Yamaguchi Y, Ito K, Khono M, Kawaguchi H, Ito K (1982) Clinico-pathological study of childhood IgA nephropathy fallen into end-stage renal disease. Pediatr Nephrol 6:F2

  23. 23.

    Berg UB (1991) Long term follow up of renal function in IgA nephropathy. Arch Dis Child 66:588–592

  24. 24.

    Soergel M, Waldherr R, Schaefer F, Schärer K (1992) IgA-nephropahty in childhood has a poor long-term prognosis. Pediatr Nephrol 6:C18

  25. 25.

    Andreoli SP, Yum MN, Bergstein JM (1986) IgA nephropathy in children: significance of glomerular basement membrane deposition of IgA. Am J Nephrol 6:28–33

  26. 26.

    Welch TR, McAdams AJ, Berry A (1988) Rapidly progressive IgA nephropathy. Am J Dis Child 142:789–793

  27. 27.

    Hogg RJ, Silva FG (1984) IgA nephropathy: natural history and prognostic indices in children. Contrib Nephrol 40:214–221

  28. 28.

    Schwartz GJ, Haycock GB, Edelmann CM, Spitzer A (1976) A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 58:259–363

  29. 29.

    Afifi AA, Clark V (1984) Computer-aided multivariate analysis. Wadsworth, Belmont, Calif., pp 246–284

  30. 30.

    SAS Institute (1988) SAS/STAT user's guide, release 6.03 edn. SAS Institute, Cary, N. C., pp 909–922

  31. 31.

    Woo KT, Edmondson RPS, Wu AYT, Chiang GSC, Pwee HS, Lim CH (1986) The natural history of IgA nephritis in Singapore. Clin Nephrol 25:15–21

  32. 32.

    Jennette JC, Wall SD, Wilkman AS (1985) Low incidence of IgA nephropathy in blacks. Kidney Int 28:944–950

  33. 33.

    Galla JH, Kohaut EC, Alexander R, Mastecky J (1984) Racial differences in the prevalence of IgA-associated nephropathies. Lancet ii:522

  34. 34.

    D'Amico G, Minetti L, Ponticelli C, Fellin G, Ferrario F, Barbiano di Belgioioso G, Imbasciati E, Ragni A, Bertoli S, Fogazzi G, Duca G (1986) Prognostic indicators of idiopathic IgA mesangial nephropathy. Q J Med 228:363–378

  35. 35.

    Beukhof JR, Kardaun O, Schaafsma W, Poortema K, Donker AJM, Hoedemaeker PH, Hem GK van der (1986) Toward individual prognosis of IgA nephropathy. Kidney Int 29:549–556

  36. 36.

    Bogenschütz O, Bohle A, Batz C, Wehrmann M, Pressler H, Kendziorra H, Gärtner HV (1990) IgA nephritis: on the importance of morphological and clinical parameters in the long-term prognosis of 239 patients. Am J Nephrol 10:137–147

  37. 37.

    Alamartine E, Sabatier J-C, Guerin C, Berliet J-M, Berthoux F (1991) Prognostic factors in mesangial IgA glomerulonephritis: an extensive study with univariate and multivariate analyses. Am J Kidney Dis 18:12–19

Download references

Author information

Correspondence to Ronald J. Hogg.

Additional information

Southwest Pediatric Nephrology Study Group (Central Office, Baylor University Medical Center at Dallas, Tex., USA). Director, Ronald J. Hogg; statistician, Joan S. Reisch; administrative assistant, Kaye Green. Centers and Physicians participating in this study: Baylor College of Medicine, Houston, Tex., Phillip L. Berry, L. Leighton Hill, Sami A. Sanjad, Edith Hawkins; Baylor University Medical Center, Dallas, Tex., Ronald J. Hogg, Daniel Savino, Kaye Green; Tulane University Medical Center, New Orleans, La., Frank Boineau, John E. Lewy, Radhakrishna Baliga, Patrick Walker; University of Arkansas, Little Rock, Ark, Watson Arnold, Eileen Ellis, Edward Uthman; University of Colorado Health Science Center, Denver, Colo., Gary M. Lum, William Hammond; University of Oklahoma Medical Center, Oklahoma City, Okla., James Wenzl, James Matson, Geoffrey Altshuler, Sarah Johnson; University of Tennessee, Memphis, Tenn., F. Bruder Stapleton, Shane Roy III, Robert J. Wyatt, Charles McKay, William Murphy; University of Texas Southwestern Medical Center at Dallas, Tex., Billy S. Arant Jr, Michel Baum, Fred G. Silva, Arthur Weinberg, Craig Argyle, Joseph Rutledge, Ed Eigenbrodt; University of Texas Medical School, Houston, Tex., Susan B. Conley, Jacques Lemire, Ron Portman, Ann Ince, Regina Verani; University of Texas Health Science Center at San Antonio, Tex., Michael Foulds, Sudesh Makker, Kanwal Kher, Melanie Sweet, Victor Saldivar, Fermin Tio; University of Texas Medical Branch, Galveston, Tex., Ben H. Brouhard, Alok Kalia, Luther B. Travis, Lisa Hollander, Tito Cavallo, Srinivasan Rajaraman; University of Utah Medical Center, Salt Lake City, Utah, Eileen Brewer, Miriam Turner, Richard Siegler, Elizabeth Hammond, Theodore Pysher; University of Kentucky College of Medicine, Lexington, Ky., Elizabeth Jackson, Nancy H. Holland, Randall Jenkins, Bonnie Mitchell.

Note: this list reflects the investigators' addresses and positions during the period of this study and not necessarily their current situations.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Hogg, R.J., Silva, F.G., Wyatt, R.J. et al. Prognostic indicators in children with IgA nephropathy — Report of the Southwest Pediatric Nephrology Study Group. Pediatr Nephrol 8, 15–20 (1994).

Download citation

Key words

  • IgA nephropathy
  • End-stage renal disease
  • Prognosis