Pediatric IgA nephropathy: clinical and therapeutic perspectives

IgA nephropathy (IgAN) is the most common glomerular disease in children and adolescents, accounting for 20% of the glomerular diseases diagnosed by renal biopsy and 30% to 40% of biopsies performed because of hematuria and/or proteinuria in children. It is likely that several cases are missed because IgAN is mostly asymptomatic and is not detectable in the majority of children who do not undergo screening programs. The natural history of IgAN in children represents, with few exceptions, the early phase of the entire course. The disease had been considered more benign than in adults, however, this was found not to be true in long-term follow-up evaluations, and the 20-year survival rates were similar in the 2 age groups. The interest on IgAN in children has increased after the consideration that most subjects with IgAN entering dialysis are young adults and, because the decline of renal function in these patients is slow (25% need dialysis in 20 years), the realization that their disease had begun in childhood. Hence, detecting IgAN at the beginning of its natural history may offer the possibility of early treatment of the nephritis and/or its complications, with benefits for patients at the pediatric age, but even more benefits later in life.