ESPN 51th Annual Meeting

ESPN 2018


 
Persistent asymptomatic isolated hematuria in children in IgA nephropathy: histopathological features and prognosis.
CAMBIER ALEXANDRA 1 MARION RABANT 2 MICHEL PEUCHMAUR 3 ANNE COUDERC 1 ALEXANDRE HERTIG 3 DESCHENES GEORGES 1 REMI SALOMON 2 JULIEN HOGAN 1 ROBERT THOMAS 4

1- Pediatric Department of Nephrology and Transplantation, Assistance Publique-Hôpitaux de Paris, Hôpital Robert-Debré, Paris, France
2- Service de Pathologie, Hôpital Universitaire Hôpital Necker APHP, Paris, France
3- Department of Nephrology, Transplantation and Emergency, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France
4- Centre de néphrologie et transplantation rénale, Assistance Publique-Hôpitaux de Marseille, Hôpital de la Conception, Marseille, France
 
Introduction:

Patients with recurrent episodes of macroscopic hematuria and persistent isolated microscopic hematuria (proteinuria<0.03g/mmol creatinuria and EGFR> 90ml/min/1.73m2) in IgA nephropathy (IgAN) does not correlate with prognosis. Early studies suggest that gross hematuria was associated with better outcome and with normal or minor abnormalities tissue on biopsy. We studied clincial and histological findings and prognosis in children with biopsy-proven with  persistent isolated microscopic hematuria.

Material and methods:

Data on 82 consecutive children were reviewed.14 children with persistent isolated microscopic hematuria (median 11.7 years old; median of clinical follow-up 4.3 years)were reviewed. Renal biopsies were scored for Oxford classification.

Results:

13 out 14 patients were male. Analysis of renal biopsies finds: Mesangial proliferation in 9 patients (64,3%), endocapillary proliferation in 7 (50%) patients and no patient have extracapillary proliferation. Focal glomerulosclerosis/adhesionwas found in 8 (57.1%) patients, podocytopathic features in 1 (8.3%) patient and no patient have tubular atrophy/interstitial fibrosis. 2 (14.3%) patients received steroid therapy and 5 (35.7%)  patients were treated with supportive care treatment alone (renin angiotensin system blockade (RASb)). At the last clinical follow up, no patients reach end-stage of renal disease, median eGFR was 100.9 ml/min/1.73m2and median proteinuria 0.15 g/g. 

Conclusions:

In western countries, recurrent isolated microscopic hematuria is not a common indication for kidney biopsy. In our study, we show that children with recurrent episodes of macroscopic hematuria and persistent isolated microscopic hematuria does not preclude normal or minor abnormalities tissue. Renal  biopsy should be proposed inchildren with recurrent episodes of macroscopic hematuria and persistent isolated microscopic hematuria. Mesangial and endocapillary proliferation is significantly associated with a poor long-term renal outcome and should open discussion about treatment (steroid therapy and/or RASb) even in absence of proteinuria and renal dysfunction.