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Clinical and Experimental Nephrology

, Volume 19, Issue 6, pp 1149–1156 | Cite as

Long-term morbidity of IgA nephropathy in children evaluated with newly proposed remission criteria in Japan

  • Shoko Matsushita
  • Kenji IshikuraEmail author
  • Shojiro Okamoto
  • Yusuke Okuda
  • Yoshinobu Nagaoka
  • Ryoko Harada
  • Riku Hamada
  • Tomoyuki Sakai
  • Yuko Hamasaki
  • Hiroshi Hataya
  • Takashi Ando
  • Kentaro Ogata
  • Masataka Honda
Original Article

Abstract

Background

The long-term outcome of pediatric IgA nephropathy (IgAN) is unclear. Objective IgAN remission criteria were proposed by the Japanese Society of Nephrology in 2013.

Methods

Children with newly developed IgAN followed for >5 years were analyzed. They were divided into two groups based on histological findings at initial kidney biopsy: the focal mesangial proliferation group (Focal group) and diffuse mesangial proliferation group (Diffuse group). The primary outcome was the remission rate according to the newly proposed IgAN remission criteria.

Results

The patients comprised 53 children (31 boys; mean age at IgAN onset, 10.0 years). The Focal and Diffuse groups comprised 21 and 32 patients, respectively. No significant differences in patient characteristics were found between the groups except for steroid administration. The median follow-up period from onset was 9.9 years. Sixteen patients in the Diffuse group and 10 in the Focal group had not achieved remission at the last observation. Patient conditions 2 years after the initial treatment were almost identical to those at the last observation. Multivariate analysis revealed that proteinuria, particularly <0.5 g/g Cr at 2 years, was significantly associated with remission at the last observation regardless of proteinuria status at the start of treatment.

Conclusions

Pediatric IgAN has a prolonged course that is longer than expected regardless of severity at diagnosis. Patient conditions 2 years after initial treatment predicted their conditions at the last observation. Although the final renal function of these patients is presently unclear, children with IgAN should be followed beyond adolescence and further into adulthood.

Keywords

IgA nephropathy Remission criteria Children 

Notes

Acknowledgments

The authors would like to thank Dr. Emi Kawaguchi of Tokyo Metropolitan Children’s Medical Center for her support in preparation of the manuscript. The authors also wish to thank Angela Morben, DVM, ELS, of Edanz Group Ltd, for providing editorial language support in the preparation of the manuscript. This work was partly supported by a Health and Labour Sciences Research Grant for Research on Rare and Intractable Diseases from the Ministry of Health, Labour and Welfare, Japan (H26-nanchitou(nan)-ippan-036).

Conflict of interest

The authors have declared that no conflict of interest exists.

References

  1. 1.
    Yoshikawa N, Tanaka R, Iijima K. Pathophysiology and treatment of IgA nephropathy in children. Pediatr Nephrol. 2001;16:446–57.CrossRefPubMedGoogle Scholar
  2. 2.
    Tomino Y, Sakai H. Clinical guidelines for immunoglobulin A (IgA) nephropathy in Japan, second version. Clin Exp Nephrol. 2003;7:93–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Haas M, Rahman MH, Cohn RA, Fathallah-Shaykh S, Ansari A, Bartosh SM. IgA nephropathy in children and adults: comparison of histologic features and clinical outcomes. Nephrol Dial Transplant. 2008;23:2537–45.CrossRefPubMedGoogle Scholar
  4. 4.
    Ikezumi Y, Suzuki T, Imai N, Ueno M, Narita I, Kawachi H, et al. Histological differences in new-onset IgA nephropathy between children and adults. Nephrol Dial Transplant. 2006;21:3466–74.CrossRefPubMedGoogle Scholar
  5. 5.
    Koyama A, Igarashi M, Kobayashi M. Natural history and risk factors for immunoglobulin A nephropathy in Japan. Research Group on Progressive Renal Diseases. Am J Kidney Dis. 1997;29:526–32.CrossRefPubMedGoogle Scholar
  6. 6.
    Kamei K, Nakanishi K, Ito S, Saito M, Sako M, Ishikura K, et al. Long-term results of a randomized controlled trial in childhood IgA nephropathy. Clin J Am Soc Nephrol. 2011;6:1301–7.PubMedCentralCrossRefPubMedGoogle Scholar
  7. 7.
    Shima Y, Nakanishi K, Kamei K, Togawa H, Nozu K, Tanaka R, et al. Disappearance of glomerular IgA deposits in childhood IgA nephropathy showing diffuse mesangial proliferation after 2 years of combination/prednisolone therapy. Nephrol Dial Transplant. 2011;26:163–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Pozzi C, Andrulli S, Pani A, Scaini P, Roccatello D, Fogazzi G, et al. IgA nephropathy with severe chronic renal failure: a randomized controlled trial of corticosteroids and azathioprine. J Nephrol. 2013;26:86–93.CrossRefPubMedGoogle Scholar
  9. 9.
    Yoshikawa N, Ito H, Sakai T, Takekoshi Y, Honda M, Awazu M, et al. A controlled trial of combined therapy for newly diagnosed severe childhood IgA nephropathy. The Japanese Pediatric IgA Nephropathy Treatment Study Group. J Am Soc Nephrol. 1999;10:101–9.PubMedGoogle Scholar
  10. 10.
    Yoshikawa N, Honda M, Iijima K, Awazu M, Hattori S, Nakanishi K, et al. Steroid treatment for severe childhood IgA nephropathy: a randomized, controlled trial. Clin J Am Soc Nephrol. 2006;1:511–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Japanese Society of Nephrology. Evidence-based clinical practice guideline for CKD 2013. Clin Exp Nephrol. 2014;18:346–423.CrossRefGoogle Scholar
  12. 12.
    Pozzi C, Andrulli S, Del Vecchio L, Melis P, Fogazzi GB, Altieri P, et al. Corticosteroid effectiveness in IgA nephropathy: long-term results of a randomized, controlled trial. J Am Soc Nephrol. 2004;15:157–63.CrossRefPubMedGoogle Scholar
  13. 13.
    Suzuki Y, Matsuzaki K, Suzuki H, Sakamoto N, Joh K, Kawamura T, et al. Proposal of remission criteria for IgA nephropathy. Clin Exp Nephrol. 2014;18:481–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Roberts IS, Cook HT, Troyanov S, Alpers CE, Amore A, Barratt J, et al. The Oxford classification of IgA nephropathy: pathology definitions, correlations, and reproducibility. Kidney Int. 2009;76:546–56.CrossRefPubMedGoogle Scholar
  15. 15.
    Uemura O, Nagai T, Ishikura K, Ito S, Hataya H, Gotoh Y, et al. Creatinine-based equation to estimate the glomerular filtration rate in Japanese children and adolescents with chronic kidney disease. Clin Exp Nephrol. 2014;18:626–33.CrossRefPubMedGoogle Scholar
  16. 16.
    Gutierrez E, Zamora I, Ballarin JA, Arce Y, Jimenez S, Quereda C, et al. Long-term outcomes of IgA nephropathy presenting with minimal or no proteinuria. J Am Soc Nephrol. 2012;23:1753–60.PubMedCentralCrossRefPubMedGoogle Scholar
  17. 17.
    Reich HN, Troyanov S, Scholey JW, Cattran DC. Remission of proteinuria improves prognosis in IgA nephropathy. J Am Soc Nephrol. 2007;18:3177–83.CrossRefPubMedGoogle Scholar
  18. 18.
    Lv J, Xu D, Perkovic V, Ma X, Johnson DW, Woodward M, et al. Corticosteroid therapy in IgA nephropathy. J Am Soc Nephrol. 2012;23:1108–16.PubMedCentralCrossRefPubMedGoogle Scholar
  19. 19.
    Coppo R, D’Amico G. Factors predicting progression of IgA nephropathies. J Nephrol. 2005;18:503–12.PubMedGoogle Scholar
  20. 20.
    Kawamura T, Yoshimura M, Miyazaki Y, Okamoto H, Kimura K, Hirano K, et al. A multicenter randomized controlled trial of tonsillectomy combined with steroid pulse therapy in patients with immunoglobulin A nephropathy. Nephrol Dial Transplant. 2014;29:1546–53.PubMedCentralCrossRefPubMedGoogle Scholar
  21. 21.
    Kawasaki Y, Takano K, Suyama K, Isome M, Suzuki H, Sakuma H, et al. Efficacy of tonsillectomy pulse therapy versus multiple-drug therapy for IgA nephropathy. Pediatr Nephrol. 2006;21:1701–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Matsuzaki K, Suzuki Y, Nakata J, Sakamoto N, Horikoshi S, Kawamura T, et al. Nationwide survey on current treatments for IgA nephropathy in Japan. Clin Exp Nephrol. 2013;17:827–33.PubMedCentralCrossRefPubMedGoogle Scholar
  23. 23.
    Coppo R, Troyanov S, Camilla R, Hogg RJ, Cattran DC, Cook HT, et al. The Oxford IgA nephropathy clinicopathological classification is valid for children as well as adults. Kidney Int. 2010;77:921–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Floege J, Feehally J. Treatment of IgA nephropathy and Henoch-Schonlein nephritis. Nat Rev Nephrol. 2013;9:320–7.CrossRefPubMedGoogle Scholar
  25. 25.
    Shima Y, Nakanishi K, Hama T, Mukaiyama H, Togawa H, Hashimura Y, et al. Validity of the Oxford classification of IgA nephropathy in children. Pediatr Nephrol. 2012;27:783–92.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Nephrology 2015

Authors and Affiliations

  • Shoko Matsushita
    • 1
    • 2
  • Kenji Ishikura
    • 1
    Email author
  • Shojiro Okamoto
    • 3
  • Yusuke Okuda
    • 1
    • 4
  • Yoshinobu Nagaoka
    • 1
    • 5
  • Ryoko Harada
    • 1
  • Riku Hamada
    • 1
  • Tomoyuki Sakai
    • 4
  • Yuko Hamasaki
    • 6
  • Hiroshi Hataya
    • 1
  • Takashi Ando
    • 7
  • Kentaro Ogata
    • 8
  • Masataka Honda
    • 1
  1. 1.Department of NephrologyTokyo Metropolitan Children’s Medical CenterFuchuJapan
  2. 2.Division of AllergyTokyo Metropolitan Children’s Medical CenterFuchuJapan
  3. 3.Department of PediatricsTokai University Hachioji HospitalHachiojiJapan
  4. 4.Department of PediatricsShiga University of Medical ScienceOtsuJapan
  5. 5.Department of PediatricsNational Hospital Organization, Hokkaido Medical CenterSapporoJapan
  6. 6.Department of Pediatric NephrologyToho University Faculty of MedicineTokyoJapan
  7. 7.Japan Clinical Research Support UnitBunkyo-kuJapan
  8. 8.Division of PathologyFederation of National Public Service Personnel Mutual Aid Associations, Tachikawa HospitalTachikawaJapan

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