Crescentic IgA nephropathy in children.

Abstract

OBJECTIVES:

Crescentic IgA nephropathy (C-IgAN) is defined as IgAN with more than 50% of glomeruli showing crescents. C-IgAN in children is rare; we investigate in detail for the first time.

METHODS:

We retrospectively analyzed the 515 consecutive children who were newly diagnosed with biopsy-proven IgAN between June 1976 and May 2010. We compared clinical and pathological findings between C-IgAN and non-C-IgAN.

RESULTS:

Among 515 cases of childhood IgAN, 25 children (4.9%) had C-IgAN. Of these 25, 16 children (64%) were referred to hospitals by annual school screening. Clinical findings showed significant differences in gross hematuria (76 vs. 50%, p = .03), excretion of proteinuria (1.9 vs. 0.5 g/day/m2, p < .0001), eGFR (102 vs. 108 ml/min/1.73 m2, p = .03), and duration from onset to renal biopsy (4.0 vs. 8.0 months, p = .04) between groups. Pathological findings showed significant differences in M1 (88 vs. 55%, p = .02), E1 (83 vs. 53%, p = .008), and presence of tubular atrophy/interstitial fibrosis (88 vs. 53%, p < .0001) between groups. The 16 children with C-IgAN were treated with prednisolone and immunosuppressant. Four cases (16%) reached chronic renal failure (eGFR < 60) at the latest observation (mean observation period: 6.0 ± 3.6 years). Patients with C-IgAN had significantly lower renal survival curve than non-C-IgAN patients according to Kaplan-Meier analysis (77.1% vs. 92.6% at 13 years, p < .0001). Compared with previous reports, however, they had better renal outcome.

CONCLUSIONS:

We confirmed the importance of school screening to find C-IgAN. Although most crescents (mean: 98.1%) of C-IgAN were cellular/fibrocellular, and acute lesions were well modified with combination therapy, the presence of tubular atrophy in C-IgAN may be the reason for poorer prognosis.

• Authors: Yuko Shima, Koichi Nakanishi, Taketsugu Hama, Hironobu Mukaiyama, Masashi Sato, Yu Tanaka, Ryojiro Tanaka, Hiroshi Kaito, Kandai Nozu, Mayumi Sako, Kazumoto Iijima, Norishige Yoshikawa
• Journal: Pediatric nephrology (Berlin, Germany) (Pediatr Nephrol) Vol. 35 Issue 6 Pg. 1005-1014 (06 2020) ISSN: 1432-198X [Electronic] Germany
• PMID: 31993782 (Publication Type: Journal Article)

Chemical References

• Glucocorticoids
• Immunosuppressive Agents
• Prednisolone

Topics

• Adolescent
• Case-Control Studies
• Child
• Disease Progression
• Female
• Glomerular Filtration Rate
• Glomerulonephritis, IGA (complications, diagnosis, pathology)
• Glucocorticoids (therapeutic use)
• Humans
• Immunosuppressive Agents (therapeutic use)
• Kaplan-Meier Estimate
• Kidney Failure, Chronic (etiology)
• Kidney Glomerulus (pathology)
• Male
• Mass Screening
• Prednisolone (therapeutic use)
• Retrospective Studies
• School Health Services