ESPN 51th Annual Meeting

ESPN 2018


 
Renal prognosis in children with IgA-nephropathy in Belarus
INA KAZYRA 1 ALEXANDER SUKALO 1 NATALIA TUR 2 MACHOVSKAYA TATJANA 1

1- BELARUS STATE MEDICAL UNIVERSITY
2- 2ND CHILDRENS HOSPTAL MINSK
 
Introduction:

IgA-nephropathy(IgAN) is the most common primary glomerulonephritis in children and a cause of end stage kidney disease(ESRD) in young adults.The aim of the study was to describe risk factors associated with progression in children with IgAN.

Material and methods:

52 patients (35 boys,17 girls), age from 6 to 17yrs (median 15) with biopsy-proven IgAN from Republic Center for Pediatric Nephrology were included. Diagnostic criteria for IgAN were based on the finding of dominant/codominant mesangial deposition of IgA on kidney tissue using MEST+C classification. The duration of follow-up from 5 months up to 5 yrs.

Results:

Most of patients (n =21) had minimal urinary changes (microhematuria and proteinuria less 0.2 g/day). Hematuria with proteinuria 0.2 -0.5 g/day was detected in 16, more than 0.5 g/day in 11. Nephrotic syndrome (NS) with hematuria and arterial hypertension (AG) developed in 4. AG in 17 (32.7%) was revealed. High level of creatinine, urea, decreased eGFR less than 60 was detected in 2, in one of them NS with hematuria and AG. High uric acid level in 8, atherogenic lipids changes in 11. 24 hours proteinuria 0.55 ± 0.1 (0-3.5 g/day, median 0.31). Morphological changes characterized by M1 in 37, E1 in 2, S1 in 27, T1 in 4, C1 in 4 children. Deposits of IgA in combination with C3 observed in 23(44%). Serum level of VEGF and TGF1β in IgAN significantly exceeded healthy peers. Correlation of TGF1β expression in renal tissue with following factors: percentage of sclerotic glomeruli, fibrotic and fibro-cellular crescents, degree of tubular atrophy and interstitial fibrosis.

Conclusions:

In childhood in most cases IgAN has a low rate of progression and does not lead to a complete loss of kidney function. The risk of rapid progression to ESRD is increased in patients with AG, proteinuria exceeding 0.5 g/day, decrease in GFR less than 60, segmental sclerosis, tubular atrophy, interstitial fibrosis, large number of IgA deposits in combination with C3, high TGF1β expression.