title: Immunoglobulin a nephropathy: Pathological markers of renal survival in paediatric patients.
abstract: IgA nephropathy (IgAN) is one of the leading causes of glomerulonephritis characterized by the findings of IgA and IgG immune deposits in the mesangium of kidney biopsies from patients with persistent microscopic haematuria. IgAN is frequently detected among adolescents and young adults. IgAN presents a highly variable course that includes a spectrum from a very mild disease to end-stage renal disease (ESRD). There are several clinical and histological factors that strongly determined the final outcome of patients with IgAN. Pathological variables associated with unfavorable outcomes are mesangial hypercellularity, segmental glomerulosclerosis, endocapillary hypercellularity and interstitial fibrosis/tubular atrophy, according to the Oxford classification. Moreover, some studies also suggest a role for complement activation in the pathogenesis of IgAN. In this regard, staining for C4d may be an independent risk factor for the development of ESRD in IgAN. Despite the growing number of studies assessing IgAN risk factors, this kind of investigation in paediatric patients is still very limited. The aim of this article is to revise pathological markers related to deterioration of renal function in paediatric patients with IgAN, particularly those that can independently affect renal survival.
authors.affiliation: Division of Clinical Nephrology, Clinics Hospital, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Rafaela Cabral Gonçalves
authors.initials: RC
authors.lastname: Fabiano
authors.affiliation: Unit of Pediatric Nephrology, Faculty of Medicine, UFMG, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Sérgio Veloso Brant
authors.initials: SV
authors.lastname: Pinheiro
authors.affiliation: Division of Renal Pathology, Clinics Hospital, UFMG, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Stanley
authors.initials: S
authors.lastname: de Almeida Araújo
authors.affiliation: Unit of Pediatric Nephrology, Faculty of Medicine, UFMG, Belo Horizonte, Minas Gerais, Brazil.|Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, UFMG, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Ana Cristina
authors.identifier: http://orcid.org/0000-0001-9222-3882
authors.initials: AC
authors.lastname: Simões E Silva
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001284:Atrophy; D015415:Biomarkers / Q000032:analysis; D001706:Biopsy; D002648:Child; D003167:Complement Activation; D015935:Complement C4b / Q000032:analysis; D018450:Disease Progression; D005260:Female; D005355:Fibrosis; D005922:Glomerulonephritis, IGA / Q000150:complications / Q000276:immunology / Q000473:pathology* / Q000503:physiopathology; D005923:Glomerulosclerosis, Focal Segmental / Q000276:immunology / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis; D007074:Immunoglobulin G / Q000032:analysis; D007676:Kidney Failure, Chronic / Q000276:immunology / Q000473:pathology* / Q000503:physiopathology; D007677:Kidney Function Tests; D007678:Kidney Glomerulus / Q000276:immunology / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D010446:Peptide Fragments / Q000032:analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D010446:Peptide Fragments; D015935:Complement C4b; C032261:complement C4d
keywords: C4d deposits; IgA nephropathy; Oxford classification; chronic kidney disease