Clinicopathological features and the prognosis of IgA nephropathy in Japanese children on long-term observation.
OBJECTIVE
Clinicopathological features were investigated to clarify the ultimate prognosis and prognostic indicators for patients with IgA nephropathy in Japanese children.


METHODS
We evaluated the outcomes of 181 patients in whom IgA nephropathy was diagnosed before the age of 15 years since September 1979 and followed-up at least for three years with regard to clinical data at the onset of symptoms and renal histologic data.


RESULTS
After mean follow-up of 7.3 years from onset, 91 patients of 181 (50.3%) were in clinical remission at the last examination, 24 (13.2%) had isolated hematuria, 59 (32.6%) had hematuria and proteinuria. Eighteen of 59 (9.9%) had proteinuria more than 1 g per 24 hours. Hypertension was observed in 12 cases and 7 (3.9%) developed end-stage renal disease. Except 7, no patient had reduced renal function and elevated serum creatinine at the final follow-up. Predicted renal survival rate from onset was 92.3% at 10 years and 89.1% at 20 years. In multivariable analysis, age at onset and chronic changes of tubulointerstitium were associated with poor outcome.


CONCLUSIONS
Of 181 children with IgA nephropathy, 50% regressed, remaining 46% had hematuria and/or proteinuria and 4% of patients lapsed into end-stage renal disease. Our results indicate that childhood IgA nephropathy has a benign course and the risk for end-stage renal disease is lower than that of adults. Age at onset and tubulointerstitial lesions were the strong predictors of a progressive course of childhood IgA nephropathy.
Nozawa
R
R
Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan. ruri-n@fmu.ac.jp
Suzuki
J
J
Takahashi
A
A
Isome
M
M
Kawasaki
Y
Y
Suzuki
S
S
Suzuki
H
H
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005922:Glomerulonephritis, IGA / Q000150:complications / Q000473:pathology*; D006417:Hematuria / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D007678:Kidney Glomerulus / Q000473:pathology; D008297:Male; D011379:Prognosis; D011507:Proteinuria / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors