Long-term outcome of childhood IgA nephropathy with minimal proteinuria

• DOI: 10.1007/s00467-015-3176-5
• Publication Date: 2015-08-03T15:50:49Z
• Authors: Asumi Higa; Yuko Shima; Taketsugu Hama; Masashi Sato; Hironobu Mukaiyama; Hiroko Togawa; Ryojiro Tanaka; Kandai Nozu; Mayumi Sako; Kazumoto Iijima; Koichi Nakanishi; Norishige Yoshikawa
• Keywords: Male; Adolescent; Angiotensin-Converting Enzyme Inhibitors; Glomerulonephritis, IGA; Prognosis; 3. Good health; Proteinuria; 03 medical and health sciences; 0302 clinical medicine; Child, Preschool; Humans; Kidney Failure, Chronic; Female; Follow-Up Studies; Retrospective Studies

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.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.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.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.