Skip to main content

Advertisement

SpringerLink
Log in

Trends in pediatric primary membranoproliferative glomerulonephritis costs and complications

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Background

Data on pediatric membranoproliferative glomerulonephritis (MPGN) epidemiology, complications, and healthcare costs are critical to our understanding of MPGN’s economic burden and of how best to direct clinical care and research efforts in the future.

Methods

We analyzed 10-year trends in epidemiology, complications, and hospital charges for pediatric primary MPGN hospitalizations using the Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Database (KID) for 1997–2006. We identified approximately 320 primary MPGN admissions per year, corresponding to approximately 4.3 % of all glomerular disease admissions.

Results

Older children were at higher risk for admission (odds ratios for ages 6–10, 11–15, and 16–18 years were 7.5, 9.3, and 4.7, respectively compared to 0–5 years; p < 0.0001). Gender, race, income, hospital location, and admission season were not significant risk factors. The incidence of MPGN admission-associated acute renal failure (ARF) increased to >147 % (from <3 to 7.4 %) over time, while admission-associated renal biopsy (approx. 34.8 %), renal replacement therapy (approx. 18.4 %), and transplantation (approx. 5 %) remained constant. Hospital length of stay (LOS) increased by 68 % (from 5.0 to 8.4 days), whereas mean total hospital charges increased by 213 % (from $13,718 to $42,891), concomitant with a strong trend from private toward public health insurance.

Conclusions

We conclude that while the incidence of pediatric primary MPGN hospitalizations has remained stable over the last 10 years, they have been associated with marked increases in the frequency of ARF, as well as dramatically increased hospital LOS and charges.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. West CD, McAdams AJ, McConville JM, Davis NC, Holland NH (1965) Hypocomplementemic and normocomplementemic persistent (chronic) glomerulonephritis: clinical and pathologic characteristics. J Pediatr 67:1089–1112

    Article  Google Scholar 

  2. Habib R, Kleinknecht C, Gubler M, Levy M (1973) Idiopathic membranoproliferative glomerulonephritis in children. Report of 105 cases. Clin Nephrol 1:194–214

    PubMed  CAS  Google Scholar 

  3. Schwertz R, De Jong R, Gretz N, Kirschfink M, Anders D, Schärer K (1996) Outcome of idiopathic membranoproliferative glomerulonephritis in children. Acta Pediatr 85:308–312

    Article  CAS  Google Scholar 

  4. Iitaka K, Nakamura S, Moriya S, Koshino H, Iwanami N, Sakai T, Motoyama O (2005) Hypocomplementemia and membranoproliferative glomeruloneophritis in children. Clin Exp Nephrol 9:31–33

    Article  PubMed  Google Scholar 

  5. Covic A, Schiller A, Volovat C, Gluhovschi G, Gusbeth-Tatomir P, Petrica L, Caruntu ID, Bozdog G, Velciov S, Trandafirescu V, Bob F, Gluhovschi C (2006) Epidemiology of renal disease in Romania: a 10 year review of two regional renal biopsy databases. Nephrol Dial Transplant 21:419–424

    Article  PubMed  Google Scholar 

  6. Asinobi AO, Gbadegesin RA, Adeyemo AA, Akang EE, Arowolo FA, Abiola OA, Osinusi K (1999) The predominance of membranoproliferative glomerulonephritis in childhood nephrotic syndrome in Ibadan, Nigeria. West Afr J Med 18:203–206

    PubMed  CAS  Google Scholar 

  7. Chang JH, Kim DK, Kim HW, Park SY, Yoo TH, Kim BS, Kang SW, Choi KH, Han DS, Jeong HJ, Lee HY (2009) Changing prevalence of glomerular diseases in Korean adults: a review of 20 years of experience. Nephrol Dial Transplant 24:2406–2410

    Article  PubMed  Google Scholar 

  8. Safaei A, Maleknejad S (2009) Spectrum of childhood nephrotic syndrome in Iran: a single center study. Indian J Nephrol 19:87–90

    Article  PubMed  CAS  Google Scholar 

  9. Swaminathan S, Leung N, Lager DJ, Melton LJ 3rd, Bergstralh EJ, Rohlinger A, Fervenza FC (2006) Changing incidence of glomerular disease in Olmsted County, Minnesota: a 30-year renal biopsy study. Clin J Am Soc Nephrol 1:483–487

    Article  PubMed  Google Scholar 

  10. Werner T, Brodersen HP, Janssen U (2009) Analysis of the spectrum of nephropathies over 24 years in a West German center based on native kidney biopsies. Med Klin (Munich) 104:753–759

    Article  Google Scholar 

  11. Hanko JB, Mullan RN, O’Rourke DM, McNamee PT, Maxwell AP, Courtney AE (2009) The changing pattern of adult primary glomerular disease. Nephrol Dial Transplant 24:3050–3054

    Article  PubMed  Google Scholar 

  12. Ben Maiz H, Abderrahim E, Ben Moussa F, Goucha R, Karoui C (2006) Epidemiology of glomerular diseases in Tunisia from 1975 to 2005. Influence of changes in healthcare and society. Bull Acad Natl Med 190:403–416, discussion 416–408

    PubMed  Google Scholar 

  13. Jalalah SM, Jamal AA (2009) Childhood primary glomerular diseases in the western region of Saudi Arabia. Saudi J Kidney Dis Transpl 20:608–612

    PubMed  Google Scholar 

  14. Ozkaya N, Cakar N, Ekim M, Kara N, Akkök N, Yalçinkaya F (2004) Primary nephrotic syndrome during childhood in Turkey. Pediatr Int 46:436–438

    Article  PubMed  Google Scholar 

  15. Benz K, Amann K (2009) Pathological aspects of membranoproliferative glomerulonephritis (MPGN) and haemolytic uraemic syndrome (HUS) / thrombocytic thrombopenic purpura (TTP). Thromb Haemost 101:265–270

    PubMed  CAS  Google Scholar 

  16. Alchi B, Jayne D (2010) Membranoproliferative glomerulonephritis. Pediatr Nephrol 25:1409–1418

    Article  PubMed  Google Scholar 

  17. Licht C, Schlotzer-Schrehardt U, Kirschfink M, Zipfel PF, Hoppe B (2007) MPGN II—genetically determined by defective complement regulation? Pediatr Nephrol 22:2–9

    Article  PubMed  Google Scholar 

  18. Licht C, Fremeaux-Bacchi V (2009) Hereditary and acquired complement dysregulation in membranoproliferative glomerulonephritis. Thromb Haemost 101:271–278

    PubMed  CAS  Google Scholar 

  19. Skerka C, Licht C, Mengel M, Uzonyi B, Strobel S, Zipfel PF, Józsi M (2009) Autoimmune forms of thrombotic microangiopathy and membranoproliferative glomerulonephritis: Indications for a disease spectrum and common pathogenic principles. Mol Immunol 46:2801–2807

    Article  PubMed  CAS  Google Scholar 

  20. Barbiano di Belgiojoso G, Baroni M, Pagliari B, Lavagni MG, Porri MT, Banfi G, Colasanti G, Confalonieri R (1985) Is membranoproliferative glomerulonephritis really decreasing? A multicentre study of 1,548 cases of primary glomerulonephritis. Nephron 40:380–381

    Article  PubMed  CAS  Google Scholar 

  21. Iitaka K, Nakamura S, Moriya S, Koshino H, Iwanami N, Sakai T, Motoyama O (2005) Hypocomplementemia and membranoproliferative glomeruloneophritis in children. Clin Exp Nephrol 9:31–33

    Article  PubMed  Google Scholar 

  22. Levey A, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, Hogg RJ, Perrone RD, Lau J, Eknoyan G, Foundation NK (2003) National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 139:137–147

    PubMed  Google Scholar 

  23. Bagshaw S, George C, Bellomo R, ANZICS Database Management Committe (2008) A comparison of the RIFLE and AKIN criteria for acute kidney injury in critically ill patients. Nephrol Dial Transplant 23:1569–1574

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was in part published as an abstract (“Epidemiology and Costs of Pediatric MPGN”) at the Annual Meeting of the Pediatric Academic Sciences in May 2010 in Vancouver, BC.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Division of Nephrology, China Medical University Hospital, Taichung, Taiwan

    Chang-Ching Wei

  2. China Medical University, Taichung, Taiwan

    Chang-Ching Wei

  3. Division of Nephrology, Nationwide Children’s Hospital, Center for Clinical and Translational Research, Columbus, OH, USA

    Wei Wang & William E. Smoyer

  4. Division of Nephrology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

    Christoph Licht

  5. University of Toronto, Toronto, ON, Canada

    Christoph Licht

Authors
  1. Chang-Ching Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wei Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. William E. Smoyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christoph Licht
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christoph Licht.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wei, CC., Wang, W., Smoyer, W.E. et al. Trends in pediatric primary membranoproliferative glomerulonephritis costs and complications. Pediatr Nephrol 27, 2243–2250 (2012). https://doi.org/10.1007/s00467-012-2249-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-012-2249-y

Keywords

Search

Navigation