NDT Advance Access originally published online on February 10, 2008
Nephrology Dialysis Transplantation 2008 23(8):2537-2545; doi:10.1093/ndt/gfn014
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IgA Nephropathy in children and adults: comparison of histologic features and clinical outcomes
1 Department of Pathology 2 Department of Medicine, Johns Hopkins Medical Institutions 3 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 4 Division of Kidney Diseases, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL 5 Department of Paediatrics, University of Wisconsin Medical School, Madison, WI, USA
Correspondence and offprint requests to: Mark Haas, Department of Pathology, Johns Hopkins University School of Medicine, 600 N. Wolfe Str., Pathology 712, Baltimore, MD 21287, USA. Tel: +1-410-614-5631; Fax: +1-410-614-7110; E-mail: mhaas{at}jhmi.edu
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Abstract |
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Background. While some studies have reported that IgA nephropathy has a relatively benign clinical course in children, others have shown that renal outcomes of paediatric patients with IgA nephropathy followed into adulthood are similar to those of patients diagnosed as adults. Some of this variability may be related to differences in histologic severity of cohorts of patients diagnosed as children versus adults.
Methods. We retrospectively examined correlations between renal biopsy findings, clinical features at presentation and renal survival in 99 children and adolescents (
17 years old) with IgA nephropathy and compared these findings to those of 125 adults with IgA nephropathy.
Results. Compared with adults, paediatric patients were more likely to have minimal histologic lesions (24% versus 14%) and less likely to have advanced chronic lesions (3% versus 17%). Similar fractions of paediatric and adult patients showed focal and diffuse glomerulonephritis (GN), respectively. Among these latter two groups, renal survival was significantly better in patients diagnosed as children than as adults by univariate and multivariate analyses. By multivariate analysis, other significant, independent predictors of renal survival were estimated percent interstitial fibrosis and histologic grade (diffuse versus focal GN).
Conclusions. In patients with proliferative IgA nephropathy, the clinical course is more likely to be benign when the disease is diagnosed in childhood versus adulthood. This difference can be accounted for only in part by more advanced disease at the time of biopsy in adults.
Keywords: Berger's disease; glomerulonephritis; IgA nephropathy; renal biopsy; renal failure
Received for publication: 6. 8.07
Accepted in revised form: 8. 1.08