All issues > Volume 50(2); 2007

Original Article

Korean J Pediatr. 2007;50(2):170-177. Published online February 15, 2007.

Clinicopathologic features and prognosis of childhood IgA nephropathy

Sung Il SI Woo¹, Keun Wook KW Bae¹, Joo Hoon JH Lee¹, Young Seo YS Park¹, Yong Mee YM Cho²

¹Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
²Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Correspondence Young Seo YS Park ,Email: yspark@amc.seoul.kr

Abstract

Purpose
: Clinicopathological features were investigated to clarify the outcome and prognostic indicators for patients with IgA nephropathy in Korean children.
Methods
: We reviewed the outcomes of 61 patients in whom IgA nephropathy was diagnosed before the age of 15 years from 1991 to 2005 and followed-up at least for one year. All patients were confirmed by renal biopsy.
Results
: After mean follow-up of 5.2 years from onset, 24 patients of 61 (39.3%) were in clinical remission at the last examination. Thirty patients (49.2%) had hematuria or mild proteinuria (<1 g/ m2/d), five (8.2%) had severe proteinuria ( 1 g/m2/d), and two (3.3%) had chronic renal failure. By univariate analysis, initial presentation at onset and Haas classification were less concordant with outcome. Hypertension during follow-up, rather than hypertension at presentation, was significantly correlated with outcomes (P<0.01). Sixty percent of patients who had more than 20% of glomerular sclerosis or crescent progressed to severe proteinuria or chronic renal failure, as compared with 7.1% of those who did not (P<0.01).
Conclusion
: Prognosis of childhood IgA nephropathy had a relatively benign course during a mean follow-up of 5.2 years. Persistent hypertension during follow-up and more than 20% of glomerular sclerosis or crescent were strong predictors of a progressive course of IgA nephropathy. A new histologic classification according to characteristics of childhood IgA nephropathy must be established to assess prognosis. Further efforts should be made to understand the prognosis of IgA nephropathy through long-term follow-up.

Keywords :Glomerulonephritis , IGA , Children , Prognosis