Abstract
Background
The long-term outcome of pediatric IgA nephropathy (IgAN) is unclear. Objective IgAN remission criteria were proposed by the Japanese Society of Nephrology in 2013.
Methods
Children with newly developed IgAN followed for >5 years were analyzed. They were divided into two groups based on histological findings at initial kidney biopsy: the focal mesangial proliferation group (Focal group) and diffuse mesangial proliferation group (Diffuse group). The primary outcome was the remission rate according to the newly proposed IgAN remission criteria.
Results
The patients comprised 53 children (31 boys; mean age at IgAN onset, 10.0 years). The Focal and Diffuse groups comprised 21 and 32 patients, respectively. No significant differences in patient characteristics were found between the groups except for steroid administration. The median follow-up period from onset was 9.9 years. Sixteen patients in the Diffuse group and 10 in the Focal group had not achieved remission at the last observation. Patient conditions 2 years after the initial treatment were almost identical to those at the last observation. Multivariate analysis revealed that proteinuria, particularly <0.5 g/g Cr at 2 years, was significantly associated with remission at the last observation regardless of proteinuria status at the start of treatment.
Conclusions
Pediatric IgAN has a prolonged course that is longer than expected regardless of severity at diagnosis. Patient conditions 2 years after initial treatment predicted their conditions at the last observation. Although the final renal function of these patients is presently unclear, children with IgAN should be followed beyond adolescence and further into adulthood.
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References
Yoshikawa N, Tanaka R, Iijima K. Pathophysiology and treatment of IgA nephropathy in children. Pediatr Nephrol. 2001;16:446–57.
Tomino Y, Sakai H. Clinical guidelines for immunoglobulin A (IgA) nephropathy in Japan, second version. Clin Exp Nephrol. 2003;7:93–7.
Haas M, Rahman MH, Cohn RA, Fathallah-Shaykh S, Ansari A, Bartosh SM. IgA nephropathy in children and adults: comparison of histologic features and clinical outcomes. Nephrol Dial Transplant. 2008;23:2537–45.
Ikezumi Y, Suzuki T, Imai N, Ueno M, Narita I, Kawachi H, et al. Histological differences in new-onset IgA nephropathy between children and adults. Nephrol Dial Transplant. 2006;21:3466–74.
Koyama A, Igarashi M, Kobayashi M. Natural history and risk factors for immunoglobulin A nephropathy in Japan. Research Group on Progressive Renal Diseases. Am J Kidney Dis. 1997;29:526–32.
Kamei K, Nakanishi K, Ito S, Saito M, Sako M, Ishikura K, et al. Long-term results of a randomized controlled trial in childhood IgA nephropathy. Clin J Am Soc Nephrol. 2011;6:1301–7.
Shima Y, Nakanishi K, Kamei K, Togawa H, Nozu K, Tanaka R, et al. Disappearance of glomerular IgA deposits in childhood IgA nephropathy showing diffuse mesangial proliferation after 2 years of combination/prednisolone therapy. Nephrol Dial Transplant. 2011;26:163–9.
Pozzi C, Andrulli S, Pani A, Scaini P, Roccatello D, Fogazzi G, et al. IgA nephropathy with severe chronic renal failure: a randomized controlled trial of corticosteroids and azathioprine. J Nephrol. 2013;26:86–93.
Yoshikawa N, Ito H, Sakai T, Takekoshi Y, Honda M, Awazu M, et al. A controlled trial of combined therapy for newly diagnosed severe childhood IgA nephropathy. The Japanese Pediatric IgA Nephropathy Treatment Study Group. J Am Soc Nephrol. 1999;10:101–9.
Yoshikawa N, Honda M, Iijima K, Awazu M, Hattori S, Nakanishi K, et al. Steroid treatment for severe childhood IgA nephropathy: a randomized, controlled trial. Clin J Am Soc Nephrol. 2006;1:511–7.
Japanese Society of Nephrology. Evidence-based clinical practice guideline for CKD 2013. Clin Exp Nephrol. 2014;18:346–423.
Pozzi C, Andrulli S, Del Vecchio L, Melis P, Fogazzi GB, Altieri P, et al. Corticosteroid effectiveness in IgA nephropathy: long-term results of a randomized, controlled trial. J Am Soc Nephrol. 2004;15:157–63.
Suzuki Y, Matsuzaki K, Suzuki H, Sakamoto N, Joh K, Kawamura T, et al. Proposal of remission criteria for IgA nephropathy. Clin Exp Nephrol. 2014;18:481–6.
Roberts IS, Cook HT, Troyanov S, Alpers CE, Amore A, Barratt J, et al. The Oxford classification of IgA nephropathy: pathology definitions, correlations, and reproducibility. Kidney Int. 2009;76:546–56.
Uemura O, Nagai T, Ishikura K, Ito S, Hataya H, Gotoh Y, et al. Creatinine-based equation to estimate the glomerular filtration rate in Japanese children and adolescents with chronic kidney disease. Clin Exp Nephrol. 2014;18:626–33.
Gutierrez E, Zamora I, Ballarin JA, Arce Y, Jimenez S, Quereda C, et al. Long-term outcomes of IgA nephropathy presenting with minimal or no proteinuria. J Am Soc Nephrol. 2012;23:1753–60.
Reich HN, Troyanov S, Scholey JW, Cattran DC. Remission of proteinuria improves prognosis in IgA nephropathy. J Am Soc Nephrol. 2007;18:3177–83.
Lv J, Xu D, Perkovic V, Ma X, Johnson DW, Woodward M, et al. Corticosteroid therapy in IgA nephropathy. J Am Soc Nephrol. 2012;23:1108–16.
Coppo R, D’Amico G. Factors predicting progression of IgA nephropathies. J Nephrol. 2005;18:503–12.
Kawamura T, Yoshimura M, Miyazaki Y, Okamoto H, Kimura K, Hirano K, et al. A multicenter randomized controlled trial of tonsillectomy combined with steroid pulse therapy in patients with immunoglobulin A nephropathy. Nephrol Dial Transplant. 2014;29:1546–53.
Kawasaki Y, Takano K, Suyama K, Isome M, Suzuki H, Sakuma H, et al. Efficacy of tonsillectomy pulse therapy versus multiple-drug therapy for IgA nephropathy. Pediatr Nephrol. 2006;21:1701–6.
Matsuzaki K, Suzuki Y, Nakata J, Sakamoto N, Horikoshi S, Kawamura T, et al. Nationwide survey on current treatments for IgA nephropathy in Japan. Clin Exp Nephrol. 2013;17:827–33.
Coppo R, Troyanov S, Camilla R, Hogg RJ, Cattran DC, Cook HT, et al. The Oxford IgA nephropathy clinicopathological classification is valid for children as well as adults. Kidney Int. 2010;77:921–7.
Floege J, Feehally J. Treatment of IgA nephropathy and Henoch-Schonlein nephritis. Nat Rev Nephrol. 2013;9:320–7.
Shima Y, Nakanishi K, Hama T, Mukaiyama H, Togawa H, Hashimura Y, et al. Validity of the Oxford classification of IgA nephropathy in children. Pediatr Nephrol. 2012;27:783–92.
Acknowledgments
The authors would like to thank Dr. Emi Kawaguchi of Tokyo Metropolitan Children’s Medical Center for her support in preparation of the manuscript. The authors also wish to thank Angela Morben, DVM, ELS, of Edanz Group Ltd, for providing editorial language support in the preparation of the manuscript. This work was partly supported by a Health and Labour Sciences Research Grant for Research on Rare and Intractable Diseases from the Ministry of Health, Labour and Welfare, Japan (H26-nanchitou(nan)-ippan-036).
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The authors have declared that no conflict of interest exists.
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Matsushita, S., Ishikura, K., Okamoto, S. et al. Long-term morbidity of IgA nephropathy in children evaluated with newly proposed remission criteria in Japan. Clin Exp Nephrol 19, 1149–1156 (2015). https://doi.org/10.1007/s10157-015-1105-3
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DOI: https://doi.org/10.1007/s10157-015-1105-3