Increased Serum IgA in Children with IgA Nephropathy, Severity of Kidney Biopsy Findings and Long-Term Outcomes.
The aim of the study was to determine whether an elevated IgA level at the time of the diagnosis of IgA nephropathy has an effect on the severity of kidney biopsy findings and long-term outcomes in children. We retrospectively studied 89 children with IgA nephropathy who were stratified into Group 1- elevated serum IgA and Group 2 - normal serum IgA at baseline. The level of IgA, proteinuria, hematuria, glomerular filtration rate (GFR) and hypertension (HTN) were compared at baseline and after the end of the follow-up period of 4.0 ± 3.1 years. Kidney biopsy findings were evaluated using the Oxford classification. The evaluation of treatment included immunosuppressive therapy and renoprotection with angiotensin converting-enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB), or no treatment. The elevated serum IgA was found in 46 (52 %) patients and normal serum IgA level was found in 43 (48 %) patients. No differences were found between the two groups regarding the mean age of patients, proteinuria, and the number of patients with reduced GFR or HTN at baseline. In kidney biopsy, mesangial proliferation and segmental sclerosis were significantly more common in Group 1 compared with Group 2 (p < 0.05). Immunosuppressive therapy was used in 67 % children in Group 1 and 75 % children in Group 2. The Kaplan-Meier survival curves for renal function (with normal GFR) and persistent proteinuria did not differ significantly depending on the serum IgA level at baseline. We conclude that in IgA nephropathy the elevated serum IgA at baseline may be associated with mesangial proliferation and segmental sclerosis contribute to glomerulosclerosis, but has no effect on the presence of proteinuria or on the worsening of kidney function during several years of disease course.
Department of Pediatrics and Nephrology, Medical University of Warsaw, 24 Marszalkowska Street, 00-576, Warsaw, Poland. mmizerskawasiak@op.pl.
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M
Mizerska-Wasiak
Department of Pathology, Medical University of Warsaw, Warsaw, Poland.
J
J
Małdyk
Department of Pediatrics and Nephrology, Medical University of Warsaw, 24 Marszalkowska Street, 00-576, Warsaw, Poland.
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M
Pańczyk-Tomaszewska
Department of Pediatrics and Nephrology, Medical University of Warsaw, 24 Marszalkowska Street, 00-576, Warsaw, Poland.
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A
Turczyn
Student Research Group at the Department of Pediatrics and Nephrology, Medical University of Warsaw, Warsaw, Poland.
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K
Cichoń-Kawa
Department of Pediatrics and Nephrology, Medical University of Bialystok, Bialystok, Poland.
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A
Rybi-Szumińska
Department of Pediatrics and Nephrology, Medical University of Bialystok, Bialystok, Poland.
A
A
Wasilewska
Department of Pediatrics and Nephrology, Ludwik Rydygier Hospital, Torun, Poland.
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A
Firszt-Adamczyk
Department of Pediatrics and Nephrology, Ludwik Rydygier Hospital, Torun, Poland.
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R
Stankiewicz
Department of Pediatric Nephrology, Medical University of Lublin, Lublin, Poland.
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B
Bieniaś
Department of Pediatric Nephrology, Medical University of Lublin, Lublin, Poland.
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M
Zajączkowska
Department of Nephrology & Kidney Transplantation and Hypertension, Children's Memorial Health Institute, Warsaw, Poland.
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K
Gadomska-Prokop
Department of Nephrology & Kidney Transplantation and Hypertension, Children's Memorial Health Institute, Warsaw, Poland.
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R
Grenda
Department of Pediatric Nephrology, Jagiellonian University of Cracow, Cracow, Poland.
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M
Miklaszewska
Department of Pediatric Nephrology, Jagiellonian University of Cracow, Cracow, Poland.
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J
Pietrzyk
Department of Pediatric Nephrology, Medical University of Wroclaw, Wroclaw, Poland.
Pukajło-Marczyk
Department of Pediatric Nephrology, Medical University of Wroclaw, Wroclaw, Poland.
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D
Zwolińska
Department and Clinic of Pediatrics, SMDZ in Zabrze, SUM in Katowice, Katowice, Poland.
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M
Szczepańska
Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, Warsaw, Poland.
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U
Demkow
Department of Pediatrics and Nephrology, Medical University of Warsaw, 24 Marszalkowska Street, 00-576, Warsaw, Poland.
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M
Roszkowska-Blaim
D000293:Adolescent; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001706:Biopsy; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D005922:Glomerulonephritis, IGA / Q000097:blood* / Q000473:pathology* / Q000628:therapy; D006801:Humans; D006977:Hypertension, Renal / Q000150:complications / Q000473:pathology; D007070:Immunoglobulin A / Q000097:blood*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000473:pathology; D007677:Kidney Function Tests; D008297:Male; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D007070:Immunoglobulin A; D007166:Immunosuppressive Agents
Biopsy; Glomerulosclerosis; Introduction; Kidney; Nephropathy; Proteinuria; Serum IgA