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Long-term outcome of childhood IgA nephropathy with minimal proteinuria

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Abstract

Background

Some patients with childhood immunoglobulin A nephropathy (IgAN) progress to end-stage renal disease within 20 years, while others achieve spontaneous remission even without medication. Prognosis of IgAN with minimal proteinuria (MP-IgAN, <0.5 g/day/1.73 m2) at diagnosis seems to be generally good. However, the long-term outcome for patients with childhood MP-IgAN has not yet been determined.

Methods

We retrospectively analyzed 385 children newly diagnosed with biopsy-proven IgAN between June 1976 and July 2009 whose renal biopsy specimens could be evaluated by the Oxford classification criteria. Of these 385 children with IgAN, 106 (27.5 %) were diagnosed with MP-IgAN. We compared clinical and pathological findings between the 106 patients with MP-IgAN and the remaining 279 patients to elucidate the characteristics of MP-IgAN in children.

Results

Patients with MP-IgAN were identified through a school screening program (73.6 %) or upon presentation with gross hematuria (26.4 %). Patients with MP-IgAN had significantly milder pathological symptoms than those with IgAN. The most frequently used therapeutic regimes were angiotensin converting enzyme inhibitors (30.2 %) and no therapy (36.8 %). None of the patients with MP-IgAN reached stage III chronic kidney disease within 15 years after onset. Four patients with MP-IgAN (3.8 %) received immunosuppressive therapy during the course of the disease.

Conclusion

Our results indicate that the outcome of patients with a diagnosis of childhood MP-IgAN is good, but that careful long-term observation is required.

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Acknowledgments

The authors wish to thank all of the participants and attending physicians for their contributions.

Conflict of interest statement

YS has received a grant from Sumitomo Dainipponn Pharma Co., Ltd., and has also received a lecture fee from Novartis Pharma K.K. TH has received a lecture fee from Novartis Pharma K.K. RT has received lecture fees from Pfizer Japan, Novartis Pharma K.K. and Asahi Kasei Pharma Corporation. KNo has received lecture fees from Novartis Pharma K.K and Otsuka Pharmaceutical Co., Ltd. KI has received grants from Takeda Pharmaceutical Co., Ltd., Asahi Kasei Pharma Corporation, Novartis Pharma K.K., and Daiichi Sankyo Healthcare Co., Ltd., and has also received lecture fees from Novartis Pharma K.K., Asahi Kasei Pharma Corporation, and Daiichi Sankyo Healthcare Co., Ltd. KN has received lecture fees from Novartis Pharma K.K., Asahi Kasei Pharma Corporation and Otsuka Pharmaceutical Co., Ltd. NY has received grants from Novartis Pharma K.K. and Asahi Kasei Pharma Corporation and has also received lecture fees from Novartis Pharma K.K. and Asahi Kasei Pharma Corporation. No other disclosures are reported.

Ethical Approval

The study was performed in accordance with the principles of the Declaration of Helsinki and was approved by regional research ethics boards.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8509, Japan

    Asumi Higa, Yuko Shima, Taketsugu Hama, Masashi Sato, Hironobu Mukaiyama, Hiroko Togawa, Koichi Nakanishi & Norishige Yoshikawa

  2. Department of Nephrology, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Hyogo, Japan

    Ryojiro Tanaka

  3. Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan

    Kandai Nozu & Kazumoto Iijima

  4. Division for Clinical Trials, Clinical Research Center, National Center for Child Health and Development, Tokyo, Japan

    Mayumi Sako

Authors
  1. Asumi Higa
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  2. Yuko Shima
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  3. Taketsugu Hama
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  4. Masashi Sato
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  5. Hironobu Mukaiyama
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  6. Hiroko Togawa
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  7. Ryojiro Tanaka
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  8. Kandai Nozu
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  9. Mayumi Sako
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  10. Kazumoto Iijima
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  11. Koichi Nakanishi
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  12. Norishige Yoshikawa
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Corresponding author

Correspondence to Koichi Nakanishi.

Additional information

Part of this study was presented at the 49th annual meeting of the Japanese Society for Pediatric Nephrology, Akita, Japan, 2014.

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Higa, A., Shima, Y., Hama, T. et al. Long-term outcome of childhood IgA nephropathy with minimal proteinuria. Pediatr Nephrol 30, 2121–2127 (2015). https://doi.org/10.1007/s00467-015-3176-5

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  • DOI: https://doi.org/10.1007/s00467-015-3176-5

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