Immunoglobulin A nephropathy in children: a review of the literature and own data
Background. Immunoglobulin A (IgA) nephropathy is the most common primary chronic glomerulopathy in adults and children. It is believed that in childhood it has a benign course, but in adults it ranks first among all glomerulopathies as a cause of end-stage renal disease at a young age. The purpose of the study was analysis of literature data, clinical, immunopathological and morphological changes in IgA nephropathy to identify children at high risk of disease progression. Materials and methods. The study included 53 patients with IgA nephropathy (36 boys, 17 girls) aged from 6 to 17 years, who were under observation at the Republican Center for Pediatric Nephrology and Renal Replacement Therapy in Minsk. Inclusion criteria: predominance of dominant/co-dominant mesangial IgA deposits in kidney specimen according to MEST-C 2016 classification. The duration of follow-up ranged from 13 months to 6 years. Results. In children with IgA nephropathy, the concentration of aberrant deGal-IgA1 was significantly higher as compared to the patients with Henoch-Schonlein nephritis and healthy individuals (p < 0.001). The risk of rapid progression and onset of end-stage renal disease is inc reased in patients with hypertension, proteinuria over 0.5 g/day, a decrease in estimated glomerular filtration rate less than 60 ml/min, the presence of segmental sclerosis, tubular atrophy, interstitial fibrosis, fibrous and fibrocellular crescents, a large number of IgA deposits in combination with C3 in the biopsy specimen. Conclusions. In childhood in most cases, IgA nephropathy has a low rate of progression and does not lead to a complete loss of kidney function.
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Rees L, Webb N, Brogan P. Paediatric nephrology. London: Oxford University Press; 2007. 618 p.
Yamada A, Fujinaga S, Sakuraya K, Satoshi A, Hirano D. Initial treatment with pulse methylprednisolone followed by short-term prednisolone and tonsillectomy for childhood IgA nephropathy. Clin Exp Nephrol. 2018 Oct;22(5):1143-1149. doi: 10.1007/s10157-018-1553-7.
KDIGO; Glomerulonephritis Work Group. KDIGO Clinical Practice Guideline for Glomerulonephritis: Сhapter 10: immunoglobulin A nephropathy. Kidney Int Suppl (2011). 2012 Jun;2(2):209-217. doi: 10.1038/kisup.2012.23.
Sanders JT, Hastings MC, Moldoveanu Z, et al. Serial Galactose-Deficient IgA1 Levels in Children with IgA Nephropathy and Healthy Controls. Int J Nephrol. 2017;2017:8210641. doi: 10.1155/2017/8210641.
Trimarchi H, Barratt J, Cattran DC, et al. Oxford Classification of IgA nephropathy 2016: an update from the IgA Nephropathy Classification Working Group. Kidney Int. 2017 May;91(5):1014-1021. doi: 10.1016/j.kint.2017.02.003.
Coppo R, D'Arrigo G, Tripepi G, et al. Is there long-term value of pathology scoring in immunoglobulin A nephropathy? A validation study of the Oxford Classification for IgA Nephropathy (VALIGA) update. Nephrol Dial Transplant. 2018 Nov 9. doi: 10.1093/ndt/gfy302.
Kawasaki Y, Ono A, Ohara S, Suzuki Y, Suyama K, Suzuki J, Hosoya M. Henoch-Schönlein purpura nephritis in childhood: pathogenesis, prognostic factors and treatment. Fukushima J Med Sci. 2013;59(1):15-26.
Wozniak A, Pluta-Hadas K, Zurawski J, et al. Electron-microscopic and immunohistochemical study in Henoch-Schoenlein nephritis. Ultrastruct Pathol. 2013 Feb;37(1):83-92. doi: 10.3109/01913123.2012.670035.
Selewski DT, Ambruzs JM, Appel GB, et al. Clinical Characteristics and Treatment Patterns of Children and Adults With IgA Nephropathy or IgA Vasculitis: Findings From the CureGN Study. Kidney Int Rep. 2018 Aug 3;3(6):1373-1384. doi: 10.1016/j.ekir.2018.07.021.
Cambier A, Rabant M, Peuchmaur M, et al. Immunosuppressive Treatment in Children With IgA Nephropathy and the Clinical Value of Podocytopathic Features. Kidney Int Rep. 2018 Mar 29;3(4):916-925. doi: 10.1016/j.ekir.2018.03.013.
Shima Y, Nakanishi K, Kaku Y, et al. Combination therapy with or without warfarin and dipyridamole for severe childhood IgA nephropathy: an RCT. Pediatr Nephrol. 2018 Nov;33(11):2103-2112. doi: 10.1007/s00467-018-4011-6.
Abdel-Hafez MA, Abdel-Nabi H, El-Gamasy M, Zayton H. Histopathological patterns of renal diseases in egyptian children: A single-center experience. Saudi J Kidney Dis Transpl. 2017 Sep-Oct;28(5):1085-1091. doi: 10.4103/1319-2442.215139.
Yamane K, Kawasaki Y, Maeda R, et al. The incidence and severity of IgA vasculitis with nephritis over a 10-year period in our hospital. Fukushima J Med Sci. 2017 Dec 19;63(3):135-140. doi: 10.5387/fms.2017-14.
Shuiai Z, Huijun S, Weizhong G, Aimin L, Jianhua M. Evaluation of TGF-β1 and MCP-1 expression and tubulointerstitial fibrosis in children with Henoch-Schönlein purpura nephritis and IgA nephropathy: A clinical correlation. Clinics (Sao Paulo). 2017 Feb 1;72(2):95-102. doi: 10.6061/clinics/2017(02)05.
Mizerska-Wasiak M, Gajewski Ł, Cichoń-Kawa K, et al. Serum GDIgA1 levels in children with IgA nephropathy and Henoch-Schönlein nephritis. Cent Eur J Immunol. 2018;43(2):162-167. doi: 10.5114/ceji.2018.77386.
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