Clinical features and prognosis in childhood IgA nephropathy.
Clinical variables and laboratory and histologic findings were evaluated in 53 children with IgA nephropathy, of whom 44 were followed for a mean period of 6.2 years (range 1.2-14). At the end of the follow-up 8 patients (18.2%) had had no urinary anomalies for at least 1 year (stage A disease), 28 (63.6%) had microscopic hematuria with proteinuria < 1 g/m2/day (stage B), 5 (11.4%) had proteinuria > 1 g/m2/day (stage C), and 3 (6.8%) had chronic renal insufficiency (stage D). None of the patients in apparent remission presented with elevated serum IgA levels at disease onset. Gross or microscopic hematuria at onset correlated with stage A/B disease at the end of follow-up (p < .05) whereas the presence of proteinuria or nephritic syndrome at onset correlated with stage C/D disease after follow-up (p > .05). Presenting features of gross or microscopic hematuria without or with proteinuria (< 0.5 g/m2/day) correlated (p < .001) with minimal glomerular abnormalities at biopsy, whereas patients with nephritic syndrome had more severe histologic pictures. The presence of proliferative glomerulonephritis with crescents correlated (p < .0001) with poor outcome. The results demonstrate that the prognosis of IgA nephropathy in childhood must be viewed with caution and that outcome correlates with mode of onset and severity of the renal pathology.
Department of Pediatrics II, University of Milan, Italy.
M
M
Giani
B
B
Damiani
L
L
Ghio
M
M
Spano
A
A
Edefonti
D000704:Analysis of Variance; D001707:Biopsy, Needle; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005922:Glomerulonephritis, IGA / Q000145:classification / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D006801:Humans; D007558:Italy; D007668:Kidney / Q000473:pathology; D008297:Male; D011379:Prognosis; D012074:Remission Induction; D016896:Treatment Outcome