Clinical and histological differences between adults and children in new onset IgA nephropathy
- 22 May 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Pediatric Nephrology
- Vol. 35 (10), 1897-1905
- https://doi.org/10.1007/s00467-020-04614-3
Abstract
Background Previous reports suggest initial presentation of IgA nephropathy (IgAN) in children is different from adults. No systematic comparison of clinical, biological, and histological childhood- and adult-onset IgAN is currently available. Methods We compared pediatric and adult clinical and histological characteristics at IgAN diagnosis. Data on 211 consecutive patients from two different centers in Paris (82 children, 129 adults) were reviewed. Kidney biopsies were scored for Oxford classification and podocytopathic (P1) features. Results We report higher eGFR at diagnosis in children compared to adults (89.5 vs. 64 ml/min/1.73 m2; p = 0.0001) but no difference in proteinuria. Histological analysis of kidney biopsy found higher proportions of mesangial (M1) and endocapillary (E1) hypercellularity in children compared with adults (M1 [80.7% vs. 27.9%, p = 0.0001]; E1 [71.3% vs. 30%, p = 0.0001]). Focal glomerulosclerosis (S1), tubular atrophy/interstitial fibrosis ≥ 25% (T1), and P1 were more frequent in adults (S1 [81.5% vs. 61.3%, p = 0.0012], T1 [49.5% vs. 1.35%, p = 0.0001], P1 [33.8% vs. 16.4%, p = 0.008). Proteinuria associated with M1, E1, and C1 in children (M1, p = 0.0001; E1, p = 0.0005; C1, p = 0.0014) but S1, P1, and T1 in adults (S1, p = 0.0001; P1, p = 0.0001; T1, p = 0.001). After steroid treatment (41 children and 28 adults), proteinuria decreased in children (p < 0.001, follow-up 38 months) and adults (p < 0.001, follow-up 76.9 months), whereas eGFR remained stable in adults but increased significantly in children (90.6 to 110 ml/min/1.73m2). Conclusion Proteinuria in children with IgAN is a marker of glomerular proliferative lesions whereas its presence in adults often reflects the presence of chronic lesions. This suggests the need for histological assessment.Keywords
This publication has 38 references indexed in Scilit:
- Validation of the Oxford classification of IgA nephropathy for pediatric patients from ChinaBMC Nephrology, 2012
- Validity of the Oxford classification of IgA nephropathy in childrenPediatric Nephrology, 2011
- Pathologic Predictors of Renal Outcome and Therapeutic Efficacy in IgA NephropathyClinical Journal of the American Society of Nephrology, 2011
- The Oxford classification of IgA nephropathy: rationale, clinicopathological correlations, and classificationKidney International, 2009
- The Oxford classification of IgA nephropathy: pathology definitions, correlations, and reproducibilityKidney International, 2009
- New Equations to Estimate GFR in Children with CKDJournal of the American Society of Nephrology, 2009
- Chronic kidney disease perspectives in Japan and the importance of urinalysis screeningClinical and Experimental Nephrology, 2008
- Renal survival in pediatric patients with IgA nephropathyPediatric Nephrology, 2007
- IgA nephropathy: Long-term prognosis for pediatric patientsThe Journal of Pediatrics, 1995
- Renal histological changes in relation to renal function and urinary protein excretion in IgA nephropathy.Archives of Disease in Childhood, 1991