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Factors related to recurrence of proteinuria in childhood IgA nephropathy

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Abstract

Background

Proteinuria remission is the most significant predictive factor for kidney outcome in childhood IgA nephropathy (c-IgAN). Even if proteinuria remission can be obtained, some patients have recurrence of proteinuria in the long-term.

Methods

This is a retrospective analysis of 312 cases of proteinuria remission among 538 consecutive children with biopsy-proven IgAN from 1976 to 2013. To elucidate the incidence and factors related to recurrence of proteinuria in c-IgAN, we compare clinical and pathological findings between patients with and without recurrence of proteinuria.

Results

Among 312 patients with remission of proteinuria, 91 (29.2%) had recurrence of proteinuria within the observation period (median 8 years). Using a multivariate Cox regression analysis, significant factors associated with recurrence of proteinuria were onset age (HR 1.13 [95%CI: 1.05–1.22], P = 0.002) and presence of hematuria after proteinuria remission (HR 2.11 [95%CI: 1.30–3.45], P = 0.003). The Kaplan–Meier analysis showed significant differences in CKD G3a-G5-free survival between the patients with no-recurrence of proteinuria, recurrence of proteinuria and non-proteinuria remission (P < 0.0001, log-rank test). Kidney survival was 100% in no-recurrence of proteinuria, 92.2% in recurrence of proteinuria, and 65.6% in non-proteinuria remission at 15 years. Cox analyses adjusted by proteinuria remission showed that recurrence of proteinuria (HR 03.10e9 [95%CI: NA], P = 0.003) was a significant factor associated with progression to CKD G3a-G5 in all patients with c-IgAN.

Conclusions

Approximately 30% of patients with proteinuria remission had recurrence of proteinuria regardless of treatment. Both remission and recurrence of proteinuria are significant prognostic factors for kidney outcome.

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Data availability

The data that support the findings of this study are available within consent upon reasonable request.

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Acknowledgements

The authors thank all participants and attending physicians for their contributions. We also thank Benjamin Phillis for editing a draft of this manuscript.

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Authors and Affiliations

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

    Yuko Shima, Hironobu Mukaiyama, Yu Tanaka & Daisuke Tokuhara

  2. Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Nishihara-Cho, Okinawa, Japan

    Wataru Shimabukuro & Koichi Nakanishi

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

    Kandai Nozu & Kazumoto Iijima

  4. Pediatric Nephrology, Hyogo Children’s Hospital, Kobe, Japan

    Hiroshi Kaito & Ryojiro Tanaka

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

    Mayumi Sako

  6. Clinical Research Center, Takatsuki General Hospital, Takatsuki City, Osaka, Japan

    Norishige Yoshikawa

Authors
  1. Yuko Shima
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  2. Hironobu Mukaiyama
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  9. Kazumoto Iijima
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  12. Koichi Nakanishi
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Contributions

Yuko Shima and Koichi Nakanishi contributed to study conception and design. Material preparation and data collection were performed by all authors. Yuko Shima and Norishige Yoshikawa performed pathological evaluations. Data analysis was performed by Yuko Shima and Koichi Nakanishi. The first draft of the manuscript was written by Yuko Shima and all authors commented on versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yuko Shima.

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Ethics approval

The study was conducted according to the principles of the Declaration of Helsinki and the ethical guidelines issued by the Ministry of Health, Labor and Welfare, Japan. The study was also approved by the Wakayama Medical University Ethics Committee (approval number: 798).

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The necessity for informed consent regarding participation was waived in accordance with the guidelines.

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The necessity for informed consent regarding publication was waived in accordance with the guidelines.

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All authors have no potential conflicts of interests to disclose

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Shima, Y., Mukaiyama, H., Tanaka, Y. et al. Factors related to recurrence of proteinuria in childhood IgA nephropathy. Pediatr Nephrol 39, 463–471 (2024). https://doi.org/10.1007/s00467-023-06116-4

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  • DOI: https://doi.org/10.1007/s00467-023-06116-4

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