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Long-term outcome 19 years after childhood IgA nephritis: a retrospective cohort study

Jaana Ronkainen1, Marja Ala-Houhala, Helena Autio-Harmainen

  • 1Department of Pediatrics and Adolescence, Oulu University Hospital, P.O. Box 23, 90029, Oulu, Finland. Matti.Nuutinen@ppshp.fi

Pediatric Nephrology (Berlin, Germany)
|July 14, 2006
PubMed

Insights

Childhood IgA nephritis can lead to long-term kidney problems, including end-stage renal disease (ESRD). Adults who had childhood IgA nephritis often experience persistent symptoms and require ongoing management, particularly during pregnancy.

Area of Science:

  • Nephrology
  • Pediatric Nephrology
  • Internal Medicine

Background:

  • Childhood IgA nephritis (IgAN) is a common glomerular disease.
  • Long-term outcomes and prognostic factors for IgAN in childhood are not fully understood.
  • Adult follow-up is crucial for managing potential long-term complications.

Purpose of the Study:

  • To evaluate the natural long-term outcome of childhood IgA nephritis.
  • To identify predictive factors for persistent nephropathy or end-stage renal disease (ESRD).
  • To assess the impact of childhood IgA nephritis on adult health, including pregnancy outcomes.

Main Methods:

  • Retrospective analysis of 55 patients with biopsy-proven childhood IgA nephritis.
  • Follow-up included health questionnaires, medical examinations, and review of medical histories and national kidney registry data.
  • Analysis of original kidney biopsy findings (chronicity index, total biopsy score) and patient demographics (age at diagnosis).

Main Results:

  • 11% of patients developed ESRD after a mean follow-up of 18.7 years.
  • 71% experienced renal symptoms, and 39% were treated for hypertension/proteinuria in adulthood.
  • Higher chronicity index and total biopsy score in initial biopsies predicted persistent nephropathy or ESRD.
  • Patients diagnosed over 16 years old had a significantly higher risk (RR 3.1) of persistent nephropathy or ESRD.
  • Pregnancy complications (proteinuria, hypertension) occurred in 55% of pregnancies, with a 30% prematurity rate.

Conclusions:

  • Childhood IgA nephritis can have significant long-term consequences into adulthood.
  • Early kidney biopsy findings are predictive of long-term renal outcomes.
  • Adolescent and adult patients, especially females during pregnancy, require vigilant long-term monitoring and management.
  • Even seemingly mild childhood IgA nephritis necessitates lifelong follow-up.

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