title: Long-term outcome of childhood IgA nephropathy with minimal proteinuria.
abstract: BACKGROUND
  Some patients with childhood immunoglobulin A nephropathy (IgAN) progress to end-stage renal disease within 20 years, while others achieve spontaneous remission even without medication. Prognosis of IgAN with minimal proteinuria (MP-IgAN, <0.5 g/day/1.73 m(2)) at diagnosis seems to be generally good. However, the long-term outcome for patients with childhood MP-IgAN has not yet been determined.
  
  
  METHODS
  We retrospectively analyzed 385 children newly diagnosed with biopsy-proven IgAN between June 1976 and July 2009 whose renal biopsy specimens could be evaluated by the Oxford classification criteria. Of these 385 children with IgAN, 106 (27.5%) were diagnosed with MP-IgAN. We compared clinical and pathological findings between the 106 patients with MP-IgAN and the remaining 279 patients to elucidate the characteristics of MP-IgAN in children.
  
  
  RESULTS
  Patients with MP-IgAN were identified through a school screening program (73.6%) or upon presentation with gross hematuria (26.4%). Patients with MP-IgAN had significantly milder pathological symptoms than those with IgAN. The most frequently used therapeutic regimes were angiotensin converting enzyme inhibitors (30.2%) and no therapy (36.8%). None of the patients with MP-IgAN reached stage III chronic kidney disease within 15 years after onset. Four patients with MP-IgAN (3.8 %) received immunosuppressive therapy during the course of the disease.
  
  
  CONCLUSIONS
  Our results indicate that the outcome of patients with a diagnosis of childhood MP-IgAN is good, but that careful long-term observation is required.
authors.affiliation: Department of Pediatrics, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8509, Japan.
authors.forename: Asumi
authors.initials: A
authors.lastname: Higa
authors.affiliation: Department of Pediatrics, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8509, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Shima
authors.affiliation: Department of Pediatrics, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8509, Japan.
authors.forename: Taketsugu
authors.initials: T
authors.lastname: Hama
authors.affiliation: Department of Pediatrics, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8509, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Sato
authors.affiliation: Department of Pediatrics, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8509, Japan.
authors.forename: Hironobu
authors.initials: H
authors.lastname: Mukaiyama
authors.affiliation: Department of Pediatrics, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8509, Japan.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Togawa
authors.affiliation: Department of Nephrology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan.
authors.forename: Ryojiro
authors.initials: R
authors.lastname: Tanaka
authors.affiliation: Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
authors.forename: Kandai
authors.initials: K
authors.lastname: Nozu
authors.affiliation: Division for Clinical Trials, Clinical Research Center, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Mayumi
authors.initials: M
authors.lastname: Sako
authors.affiliation: Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
authors.forename: Kazumoto
authors.initials: K
authors.lastname: Iijima
authors.affiliation: Department of Pediatrics, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8509, Japan. knakanis@wakayama-med.ac.jp.
authors.forename: Koichi
authors.initials: K
authors.lastname: Nakanishi
authors.affiliation: Department of Pediatrics, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8509, Japan.
authors.forename: Norishige
authors.initials: N
authors.lastname: Yoshikawa
mesh_terms: D000293:Adolescent; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005922:Glomerulonephritis, IGA / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology*; D008297:Male; D011379:Prognosis; D011507:Proteinuria / Q000150:complications*; D012189:Retrospective Studies
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: Angiotensin converting enzyme inhibitor; Crescents; End-stage renal disease; Immunosuppressive therapy; Mesangial score