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Clinical and histological differences between adults and children in new onset IgA nephropathy

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Abstract

Background

Previous reports suggest initial presentation of IgA nephropathy (IgAN) in children is different from adults. No systematic comparison of clinical, biological, and histological childhood- and adult-onset IgAN is currently available.

Methods

We compared pediatric and adult clinical and histological characteristics at IgAN diagnosis. Data on 211 consecutive patients from two different centers in Paris (82 children, 129 adults) were reviewed. Kidney biopsies were scored for Oxford classification and podocytopathic (P1) features.

Results

We report higher eGFR at diagnosis in children compared to adults (89.5 vs. 64 ml/min/1.73 m2; p = 0.0001) but no difference in proteinuria. Histological analysis of kidney biopsy found higher proportions of mesangial (M1) and endocapillary (E1) hypercellularity in children compared with adults (M1 [80.7% vs. 27.9%, p = 0.0001]; E1 [71.3% vs. 30%, p = 0.0001]). Focal glomerulosclerosis (S1), tubular atrophy/interstitial fibrosis ≥ 25% (T1), and P1 were more frequent in adults (S1 [81.5% vs. 61.3%, p = 0.0012], T1 [49.5% vs. 1.35%, p = 0.0001], P1 [33.8% vs. 16.4%, p = 0.008). Proteinuria associated with M1, E1, and C1 in children (M1, p = 0.0001; E1, p = 0.0005; C1, p = 0.0014) but S1, P1, and T1 in adults (S1, p = 0.0001; P1, p = 0.0001; T1, p = 0.001). After steroid treatment (41 children and 28 adults), proteinuria decreased in children (p < 0.001, follow-up 38 months) and adults (p < 0.001, follow-up 76.9 months), whereas eGFR remained stable in adults but increased significantly in children (90.6 to 110 ml/min/1.73m2).

Conclusion

Proteinuria in children with IgAN is a marker of glomerular proliferative lesions whereas its presence in adults often reflects the presence of chronic lesions. This suggests the need for histological assessment.

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Author notes

  1. Marion Rabant and Khalil El Karoui contributed equally to this work.

Authors and Affiliations

  1. Service de néphrologie pédiatrique, APHP, Hôpital Universitaire Robert-Debré, 48 Boulevard Serrurier, 75019, Paris, France

    Alexandra Cambier, Georges Deschenes & Julien Hogan

  2. Service de Pathologie, Hôpital Universitaire Hôpital Necker, APHP, Paris, France

    Marion Rabant

  3. Service de néphrologie et transplantation rénale, Hôpital Universitaire Henri-Mondor, Paris, France

    Khalil El Karoui

  4. Service de Pathologie, Hôpital Universitaire Robert Debré APHP, Paris et Université Diderot, Paris, France

    Michel Peuchmaur

  5. Service de néphrologie et transplantation rénale, Hôpital Necker, APHP, Paris, France

    Aude Servais

  6. Service des urgences néphrologiques et transplantation rénales, APHP, Hôpital Universitaire Tenon, Paris, France

    Alexandre Hertig

  7. Université Pierre et Marie Curie Paris 6, Paris, France

    Alexandre Hertig

  8. Service de néphrologie pédiatrique, APHP, Hôpital Universitaire Necker, Paris, France

    Remi Salomon

  9. Centre de néphrologie et transplantation rénale, APHM, Hôpital Universitaire de la Conception, 147 Bd Baille, 13385, Marseille, France

    Thomas Robert

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  1. Alexandra Cambier
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Correspondence to Alexandra Cambier or Thomas Robert.

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Cambier, A., Rabant, M., El Karoui, K. et al. Clinical and histological differences between adults and children in new onset IgA nephropathy. Pediatr Nephrol 35, 1897–1905 (2020). https://doi.org/10.1007/s00467-020-04614-3

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