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The spectrum and changes of biopsy-proven kidney diseases in Chinese children

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Abstract

Aim

The study aimed to investigate the spectrum of biopsy-proven kidney disease in Chinese children.

Methods

Records of children 0–17 years old who underwent native kidney biopsy from June 1st, 2013 to December 31st, 2018 in the national inpatients' database of China were analyzed. Biopsy-proven kidney diseases of different sex, age groups, and diagnosis, and the changing patterns of kidney disease compared with the previous study were analyzed.

Results

A total of 21,311 patients from 232 hospitals with a median age of 11.34 years were included. Immunoglobulin A vasculitis with nephritis (IgAVN) was the most common pathological finding [29.17%, 95% confidence interval (confidence interval, CI) = 28.56–29.78], followed by IgA nephropathy (IgAN) (22.70%, 95% CI = 22.14–23.27).

IgAN was the most common finding in patients with hematuria (60.75%, 95% CI = 58.83–62.65], proteinuria (33.43%, 95% CI = 30.54–36.42), and hematuria plus proteinuria (62.77%, 95% CI = 56.19–69.02). Minimal change disease was the most common finding (40.69%, 95% CI = 39.41–41.98) in nephrotic syndrome.

The proportion of IgAVN in patients with biopsy-proven glomerular disease increased year by year during 2013–2018 (p for trend < 0.001) and was higher than that of 2004–2014 [29.41% (95% CI = 29.10–29.72) in 2013–2018 vs. 13.35% (95% CI = 12.97–13.73) 2004–2014, p < 0.001]. The proportion of hepatitis B virus associated nephritis during 2013–2018 was lower than that of  2004–2014 [0.44% (95% CI = 0.36–0.54) in 2013–2018 vs. 0.87% (95% CI = 0.67–1.10) in 2004–2014, p < 0.001].

Conclusions

IgAVN and IgAN were the most common types of pathological findings in children who underwent kidney biopsies from 2013 to 2018. The pathological spectrum of kidney biopsy changed over time.

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Data availability

The datasets generated and analyzed during the current study are not publicly available due to the Hospital Quality Monitoring System (HQMS) database management rules. However, they are available from the corresponding author upon reasonable request. The SAS codes used to produce the results in this article are available from the corresponding author on request.

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Acknowledgements

The authors thank the Bureau of Medical Administration and Medical Service Supervision, NHC of the People's Republic of China, all study participants, and the original data creators for forming the dataset. We thank Yangfeng Wu, M.D., Ph.D., Peking University Clinical Research Institute, and Luxia Zhang, M.D., M.P.H, Peking University First Hospital, for their helpful advice in revising the manuscript. We thank Ying Shi, B.M.S., and Lanxia Gan, B.S., China Standard Medical Information Research Center, Shenzhen, China, for their helpful advice in the data analysis process. The first author of this article, GH, started her postdoctoral research in the First Affiliated Hospital of Sun Yat-sen University during the submission stage, so we thank Prof. Xiaoyun Jiang, and the the First Affiliated Hospital of Sun Yat-sen University for supporting GH in finishing all the process of submission and revision.

Funding

This work was funded by the Beijing Natural Science Foundation (Z190023), the Capital Characteristic Clinical Application Research supported by Beijing Municipal Science & Technology Commission (Z181100001718134), the Peking University Medicine Seed Fund for Interdisciplinary Research supported by “the Fundamental Research Funds for the Central Universities” (BMU2018MI015), and the Beijing Key Laboratory of Molecular Diagnosis and Study on Pediatric Genetic Diseases (BZ0317).

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Authors and Affiliations

  1. Department of Pediatrics, Peking University First Hospital, Beijing, China

    Guohua He, Xuhui Zhong & Jie Ding

  2. Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China

    Liyuan Tao

  3. Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China

    Chenglong Li

  4. Clinical Trial Unit, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China

    Haibo Wang

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  1. Guohua He
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Contributions

GH contributed to the design, analysis of the data, and drafting of the article; LT contributed to the design and interpretation of the data; CL performed the statistical analysis and drafting of the article; XZ and HW contributed to the design of the study and the revised of the manuscript; JD is responsible for supervision for design, interpretation of the data, and revising the article. Each author contributed important intellectual content during this article's drafting and revision and approved the final version of the article.

Corresponding author

Correspondence to Jie Ding.

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All authors declared no potential conflicts of interest.

Ethical approval

This retrospective study involves human participants following the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study protocol was reviewed and approved by the Ethics Committee Board of Peking University First Hospital (approval number: 2021 [009]).

Consent to participate

This research study was conducted retrospectively from data obtained for clinical and quality monitoring purposes. The use of this de-identified dataset in this study was approved by the Ethics Committee Board of Peking University First Hospital with a waiver of informed consent.

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This retrospective study used a de-identified dataset. Consent to publish from participants could not be applied in this study.

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Software: SAS software 9.4 (SAS Inc., Cary, NC, USA), RRID: SCR_008567.

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He, G., Tao, L., Li, C. et al. The spectrum and changes of biopsy-proven kidney diseases in Chinese children. J Nephrol 36, 417–427 (2023). https://doi.org/10.1007/s40620-022-01527-2

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