title: Predictors of Progression in IgA Nephropathy in Childhood.
abstract: The aim of this retrospective study was to assess the usefulness of potential predictors of poor prognosis in IgA nephropathy in children. The study population consisted of 55 children aged 11 ± 4 years, diagnosed on the basis of the Oxford classification and MEST score of kidney biopsy findings. Proteinuria, glomerular filtration rate (GFR), and the IgA/C3 serum ratio were assessed in all patients twice: at onset and at follow-up. The patients were treated with steroids, immunosuppressive drugs, and/or angiotensin-converting enzyme inhibitors. Follow-up was at 3.9 ± 2.9 (median 2.7) years. The patients were subdivided into two groups: with GFR <90 and ≥90 mL/min at follow-up. ROC AUC curves and logistic regression were used to evaluate the power of prognostic factors. The two groups did not differ regarding the level of proteinuria, MEST score, and the IgA/C3 ratio at onset of disease. There was a significant association between GFR reductions at onset and follow-up (AUC = 0.660; p < 0.05). In patients with nephrotic range proteinuria at onset, proteinuria at follow-up was more frequent compared with other patients (AUC = 0.760; p < 0.05), MEST score ≥3 tended to be associated with reduced GFR (AUC = 0.650; p = 0.07) but not with proteinuria (AUC = 0.608; p = 0.47), and the IgA/C3 ratio was higher (p < 0.05) at follow-up. No significant associations were found between the IgA/C3 ratio at onset and reduced GFR (AUC = 0.565; p = 0.46) or proteinuria at follow-up (AUC = 0.263; p = 0.20). We conclude that predictors of poor outcome in childhood IgAN include the following: GFR reduction, nephrotic range proteinuria at onset of disease, and high MEST score in Oxford classification of kidney biopsy. Despite a higher serum IgA/C3 ratio in children with impaired renal function in long-term follow-up, we failed to demonstrate a significant association between this ratio at onset of disease and reduced GFR or persistent proteinuria at follow-up. Thus, IgA/C3 ratio is not a good foreteller of progression of IgA nephropathy in childhood.
authors.affiliation: Department of Pediatrics and Nephrology, Medical University of Warsaw, 63A Zwirki i Wigury St., Warsaw, 02-091, Poland. wasiaczki@wp.pl.
authors.forename: M
authors.initials: M
authors.lastname: Mizerska-Wasiak
authors.affiliation: Department of Pathology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: J
authors.initials: J
authors.lastname: Małdyk
authors.affiliation: Department of Pediatrics and Nephrology, Medical University of Warsaw, 63A Zwirki i Wigury St., Warsaw, 02-091, Poland.
authors.forename: A
authors.initials: A
authors.lastname: Turczyn
authors.affiliation: Student Research Group at the Department of Pediatrics and Nephrology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: K
authors.initials: K
authors.lastname: Cichoń-Kawa
authors.affiliation: Department of Pediatrics and Nephrology, Medical University of Bialystok, Bialystok, Poland.
authors.forename: A
authors.initials: A
authors.lastname: Rybi-Szumińska
authors.affiliation: Department of Pediatrics and Nephrology, Medical University of Bialystok, Bialystok, Poland.
authors.forename: A
authors.initials: A
authors.lastname: Wasilewska
authors.affiliation: Department of Pediatric Nephrology, Medical University of Lublin, Lublin, Poland.
authors.forename: B
authors.initials: B
authors.lastname: Bieniaś
authors.affiliation: Department of Pediatric Nephrology, Medical University of Lublin, Lublin, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Zajączkowska
authors.affiliation: Department of Pediatric Nephrology, Jagiellonian University of Cracow, Cracow, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Miklaszewska
authors.affiliation: Department of Pediatric Nephrology, Jagiellonian University of Cracow, Cracow, Poland.
authors.forename: J
authors.initials: J
authors.lastname: Pietrzyk
authors.affiliation: Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, Warsaw, Poland.
authors.forename: U
authors.initials: U
authors.lastname: Demkow
authors.affiliation: Department of Pediatrics and Nephrology, Medical University of Warsaw, 63A Zwirki i Wigury St., Warsaw, 02-091, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Roszkowska-Blaim
authors.affiliation: Department of Pediatrics and Nephrology, Medical University of Warsaw, 63A Zwirki i Wigury St., Warsaw, 02-091, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Pańczyk-Tomaszewska
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D002648:Child; D003176:Complement C3 / Q000032:analysis; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D005922:Glomerulonephritis, IGA / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011507:Proteinuria / Q000503:physiopathology; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D015415:Biomarkers; C038245:C3 protein, human; D003176:Complement C3; D007070:Immunoglobulin A; D007166:Immunosuppressive Agents; D013256:Steroids