Clinical characteristics of concomitant nephrotic IgA nephropathy and minimal change disease in children.
BACKGROUND
IgA nephropathy (IgAN) is the most common primary glomerulonephritis in children and adolescents worldwide. Meanwhile, minimal change disease (MCD) is the most common cause of nephrotic syndrome in children. Recently, several case reports have revealed that IgAN can be complicated by MCD in adults. Here, we report our experience concerning the features of such patients in pediatrics.


METHODS
The clinical manifestations and pathological features of 197 children who presented with IgAN from December 2007 to November 2013 were analyzed retrospectively based on the criteria for nephrotic syndrome and MCD.


RESULTS
Among the 197 children diagnosed with primary IgAN, 25 (12.7%) patients presented with nephrotic syndrome, and 7 patients (2.8%) presented with MCD-like pathological features and nephrotic syndrome simultaneously. The cohort of 7 patients included 5 boys, and the median age was 8.9. All of the patients who were diagnosed with primary nephrotic syndrome were treated initially with corticosteroids. Except for 1 patient with steroid resistance who was lost to follow-up, the other 6 cases presented were steroid sensitive and remained in complete remission for the last follow-up, with median and mean follow-up durations of 30.5 and 34.5 months, respectively (range 10-65 months).


CONCLUSIONS
This study revealed that IgAN and MCD may also coexist in children. Moreover, most of these patients who presented with nephrotic syndrome responded well to steroids and had a favorable prognosis. Large-scale studies are required, and careful attention should be paid to such complicated cases.
Department of Nephrology, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China.
Huijun
H
Shen
Weizhong
W
Gu
Jianhua
J
Mao
Xiujuan
X
Zhu
Xia
X
Jin
Haidong
H
Fu
Aimin
A
Liu
Qiang
Q
Shu
Lizhong
L
Du
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005922:Glomerulonephritis, IGA / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D007668:Kidney / Q000473:pathology; D008297:Male; D009402:Nephrosis, Lipoid / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D011507:Proteinuria / Q000188:drug therapy / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000806:Angiotensin-Converting Enzyme Inhibitors