title: Improved renal survival in Japanese children with IgA nephropathy.
abstract: Since the beginning of the 1990s, Japanese medical practitioners have extensively prescribed angiotensin-converting enzyme (ACE) inhibitors for children with mild IgA nephropathy (IgA-N) and steriods for those with severe IgA-N. We have performed a retrospective cohort study to clarify whether the long-term outcome has improved in Japanese children with IgA-N. Renal survival was defined as the time from onset to end-stage renal disease (ESRD). We divided the study period into two time periods based on the occurrence of the initial renal biopsy:1976-1989 and 1990-2004. Actuarial survivals were calculated by Kaplan-Meier method, and comparisons were made with the logrank test. The Cox proportional hazard model was used for multivariate analysis. Between 1976 and 2004, 500 children were diagnosed as having IgA-N in our hospitals. The actuarial renal survival from the time of apparent disease onset was 96.4% at 10 years, 84.5% at 15 years and 73.9% at 20 years. Renal survival in the 1990-2004 period was significantly better than that in 1976-1989 (p=0.008), and a marked improvement in renal survival in patients with severe IgA-N was also observed (p=0.0003). Multivariate analysis indicated that diagnosis year was a significant factor for ESRD-free survival independently of baseline characteristics. The results of this study show that there has been an improvement in terms of renal survival in Japanese children with IgA-N.
authors.affiliation: Department of Pediatrics, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan.
authors.forename: Nahoko
authors.initials: N
authors.lastname: Yata
authors.forename: Koichi
authors.initials: K
authors.lastname: Nakanishi
authors.forename: Yuko
authors.initials: Y
authors.lastname: Shima
authors.forename: Hiroko
authors.initials: H
authors.lastname: Togawa
authors.forename: Mina
authors.initials: M
authors.lastname: Obana
authors.forename: Mayumi
authors.initials: M
authors.lastname: Sako
authors.forename: Kandai
authors.initials: K
authors.lastname: Nozu
authors.forename: Ryojiro
authors.initials: R
authors.lastname: Tanaka
authors.forename: Kazumoto
authors.initials: K
authors.lastname: Iijima
authors.forename: Norishige
authors.initials: N
authors.lastname: Yoshikawa
mesh_terms: D000293:Adolescent; D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D044466:Asian People / Q000706:statistics & numerical data; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D005922:Glomerulonephritis, IGA / Q000150:complications / Q000188:drug therapy* / Q000208:ethnology* / Q000401:mortality / Q000473:pathology; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000208:ethnology* / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000517:prevention & control*; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D005938:Glucocorticoids