Abstract
Investigators in 13 pediatric nephrology centers reviewed clinical and pathological features in 218 children and adolescents with IgA nephropathy (IgAN), with particular emphasis on 80 patients who had follow-up periods of at least 4 years. Potential prognostic markers in the 80 children were compared between 12 (15%) who developed end-stage renal disease (ESRD) versus 68 who did not. The relationship between clinical and pathological features and the subsequent development of ESRD was examined using stepwise linear discriminant analysis in addition to standard univariate analysis. Seven variables were found to be predictive of ESRD: the presence of glomerular sclerotic changes, especially when this was associated with proliferation or sclerosis in 20% or more of the glomeruli, black race; hypertension at biopsy; proteinuria at biopsy; age at presentation; crescents; male sex. Using the resulting discriminant function, development of ESRD could be correctly predicted in 95% of the subjects. We conclude that ESRD is more common in American children with IgAN than was realized previously. Risk factors previously documented in adult studies have been confirmed, especially the presence of glomerular sclerosis, proteinuria, and hypertension.
Similar content being viewed by others
References
Noel LH, Droz D, Gascon M, Berger J (1987) Primary IgA nephropathy: from the first-described cases to the present. Semin Nephrol 7:351–354
Neelakantappa K, Gallo GR, Baldwin DS (1987) Proteinuria in IgA nephropathy. Semin Nephrol 7:344–345
Velo M, Lozano L, Egido J, Gutierrez-Millet, Hernando L (1987) Natural history of IgA nephropathy in patients followed-up for more than ten years in Spain. Semin Nephrol 7:346–350
D'Amico G, Colasanti G, Barbiano di Belgioioso G, Fellin G, Ragni A, Egidi F, Radaelli L, Fogazzi G, Ponticelli C, Minetti L (1987) Long-term follow-up of IgA mesangial nephropathy: clinico-histological study in 374 patients. Semin Nephrol 7:355–358
Rambausek M, Rauterberg E-W, Waldherr R, Demaine A, Krupp G, Ritz E (1987) Evolution of IgA glomerulonephritis: relation to morphology, immunogenetics, and BP. Semin Nephrol 7:370–373
Clarkson AR, Woodroffe AJ, Aarons I (1987) IgA nephropathy in patients followed-up for at least ten years. Semin Nephrol 7:377–378
Magil AB, Ballon HS (1987) IgA nephropathy: evaluation of prognostic factors in patients with moderate disease. Nephron 47:246–252
Levy M, Beaufils H, Gubler MC, Habib R (1973) Idiopathic recurrent macroscopic hematuria and mesangial IgA-IgG deposits in children (Berger's disease). Clin Nephrol 1:63–69
Michalk D, Waldherr R, Seelig HP, Weber HP, Scharer K (1980) Idiopathic mesangial IgA-glomerulonephritis in childhood. Description of 19 pediatric cases and review of the literature. Eur J Pediatr 134:13–22
Southwest Pediatric Nephrology Study Group (1982) A multicenter study of IgA nephropathy in children. Kidney Int 22:643–652
Yoshikawa N, Matsuo T (1984) IgA nephropathy in children. Compr Ther 10:35–41
Kitajima T, Murakami M, Sakai O (1983) Clinicopathological features in the Japanese patients with IgA nephropathy. Jpn J Med 22: 219–222
Kher KK, Makker SP, Moorthy B (1983) IgA nephropathy (Berger's disease)— a clinicopathologic study in children. Int J Pediatr Nephrol 4:11–18
Taylor J, Risdon RA, Barratt TM, Dillon MJ (1989) Long term follow up of IgA nephropathy in children. Pediatr Nephrol 3:C155
Linné T, Berg U, Bohman S-O, Sigström L (1991) Course and long-term outcome of idiopathic IgA nephropathy in children. Pediatr Nephrol 5:383–386
Mina SN, Murphy WM (1985) IgA nephropathy: a comparative study of the clinicopathologic features in children and adults. Am J Clin Pathol 83:669–675
Wyatt RJ, Julian BA, Bhathena DB, Mitchell BL, Holland NH, Malluche HH (1984) IgA nephropathy: presentation, clinical course, and prognosis in children and adults. Am J Kidney Dis 4:192–200
Levy M, Gonzalez-Burchard G, Broyer M, Dommergues J-P, Foulard M, Sorez J-P, Habib R (1985) Berger's disease in children. Natural history and outcome. Medicine (Baltimore) 64:157–180
Hattori S, Karashima S, Furuse A, Terashima T, Hiramatsu M, Murakami M, Matsuda I (1985) Clincopathologic correlation of IgA nephropathy in children. Am J Nephrol 5:182–189
Yoshikawa N, Ito H, Yoshiara S, Nakahara C, Yoshiya K, Hasegawa O, Matsuo T (1987) Clinical course of immunoglobulin A nephropathy in children. J Pediatr 110:555–560
Kusumoto Y, Takebayashi S, Taguchi T, Harada T, Naito S (1987) Long-term prognosis and prognostic indices of IgA nephropathy in juvenile and in adult Japanese. Clin Nephrol 3:118–124
Hattori M, Tokuyama M, Yamaguchi Y, Ito K, Khono M, Kawaguchi H, Ito K (1982) Clinico-pathological study of childhood IgA nephropathy fallen into end-stage renal disease. Pediatr Nephrol 6:F2
Berg UB (1991) Long term follow up of renal function in IgA nephropathy. Arch Dis Child 66:588–592
Soergel M, Waldherr R, Schaefer F, Schärer K (1992) IgA-nephropahty in childhood has a poor long-term prognosis. Pediatr Nephrol 6:C18
Andreoli SP, Yum MN, Bergstein JM (1986) IgA nephropathy in children: significance of glomerular basement membrane deposition of IgA. Am J Nephrol 6:28–33
Welch TR, McAdams AJ, Berry A (1988) Rapidly progressive IgA nephropathy. Am J Dis Child 142:789–793
Hogg RJ, Silva FG (1984) IgA nephropathy: natural history and prognostic indices in children. Contrib Nephrol 40:214–221
Schwartz GJ, Haycock GB, Edelmann CM, Spitzer A (1976) A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 58:259–363
Afifi AA, Clark V (1984) Computer-aided multivariate analysis. Wadsworth, Belmont, Calif., pp 246–284
SAS Institute (1988) SAS/STAT user's guide, release 6.03 edn. SAS Institute, Cary, N. C., pp 909–922
Woo KT, Edmondson RPS, Wu AYT, Chiang GSC, Pwee HS, Lim CH (1986) The natural history of IgA nephritis in Singapore. Clin Nephrol 25:15–21
Jennette JC, Wall SD, Wilkman AS (1985) Low incidence of IgA nephropathy in blacks. Kidney Int 28:944–950
Galla JH, Kohaut EC, Alexander R, Mastecky J (1984) Racial differences in the prevalence of IgA-associated nephropathies. Lancet ii:522
D'Amico G, Minetti L, Ponticelli C, Fellin G, Ferrario F, Barbiano di Belgioioso G, Imbasciati E, Ragni A, Bertoli S, Fogazzi G, Duca G (1986) Prognostic indicators of idiopathic IgA mesangial nephropathy. Q J Med 228:363–378
Beukhof JR, Kardaun O, Schaafsma W, Poortema K, Donker AJM, Hoedemaeker PH, Hem GK van der (1986) Toward individual prognosis of IgA nephropathy. Kidney Int 29:549–556
Bogenschütz O, Bohle A, Batz C, Wehrmann M, Pressler H, Kendziorra H, Gärtner HV (1990) IgA nephritis: on the importance of morphological and clinical parameters in the long-term prognosis of 239 patients. Am J Nephrol 10:137–147
Alamartine E, Sabatier J-C, Guerin C, Berliet J-M, Berthoux F (1991) Prognostic factors in mesangial IgA glomerulonephritis: an extensive study with univariate and multivariate analyses. Am J Kidney Dis 18:12–19
Author information
Authors and Affiliations
Additional information
Southwest Pediatric Nephrology Study Group (Central Office, Baylor University Medical Center at Dallas, Tex., USA). Director, Ronald J. Hogg; statistician, Joan S. Reisch; administrative assistant, Kaye Green. Centers and Physicians participating in this study: Baylor College of Medicine, Houston, Tex., Phillip L. Berry, L. Leighton Hill, Sami A. Sanjad, Edith Hawkins; Baylor University Medical Center, Dallas, Tex., Ronald J. Hogg, Daniel Savino, Kaye Green; Tulane University Medical Center, New Orleans, La., Frank Boineau, John E. Lewy, Radhakrishna Baliga, Patrick Walker; University of Arkansas, Little Rock, Ark, Watson Arnold, Eileen Ellis, Edward Uthman; University of Colorado Health Science Center, Denver, Colo., Gary M. Lum, William Hammond; University of Oklahoma Medical Center, Oklahoma City, Okla., James Wenzl, James Matson, Geoffrey Altshuler, Sarah Johnson; University of Tennessee, Memphis, Tenn., F. Bruder Stapleton, Shane Roy III, Robert J. Wyatt, Charles McKay, William Murphy; University of Texas Southwestern Medical Center at Dallas, Tex., Billy S. Arant Jr, Michel Baum, Fred G. Silva, Arthur Weinberg, Craig Argyle, Joseph Rutledge, Ed Eigenbrodt; University of Texas Medical School, Houston, Tex., Susan B. Conley, Jacques Lemire, Ron Portman, Ann Ince, Regina Verani; University of Texas Health Science Center at San Antonio, Tex., Michael Foulds, Sudesh Makker, Kanwal Kher, Melanie Sweet, Victor Saldivar, Fermin Tio; University of Texas Medical Branch, Galveston, Tex., Ben H. Brouhard, Alok Kalia, Luther B. Travis, Lisa Hollander, Tito Cavallo, Srinivasan Rajaraman; University of Utah Medical Center, Salt Lake City, Utah, Eileen Brewer, Miriam Turner, Richard Siegler, Elizabeth Hammond, Theodore Pysher; University of Kentucky College of Medicine, Lexington, Ky., Elizabeth Jackson, Nancy H. Holland, Randall Jenkins, Bonnie Mitchell.
Note: this list reflects the investigators' addresses and positions during the period of this study and not necessarily their current situations.
Rights and permissions
About this article
Cite this article
Hogg, R.J., Silva, F.G., Wyatt, R.J. et al. Prognostic indicators in children with IgA nephropathy — Report of the Southwest Pediatric Nephrology Study Group. Pediatr Nephrol 8, 15–20 (1994). https://doi.org/10.1007/BF00868251
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00868251