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Improved renal survival in Japanese children with IgA nephropathy

Nahoko Yata1, Koichi Nakanishi, Yuko Shima

  • 1Department of Pediatrics, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan.

Pediatric Nephrology (Berlin, Germany)
|January 29, 2008
PubMed

Insights

Treatment advancements have improved long-term renal survival for Japanese children with IgA nephropathy (IgA-N). Outcomes were significantly better after 1990, especially for severe cases, indicating a positive trend in pediatric kidney disease management.

Area of Science:

  • Pediatric Nephrology
  • Immunology
  • Clinical Epidemiology

Background:

  • IgA nephropathy (IgA-N) is a common pediatric kidney disease.
  • Treatment strategies for IgA-N in Japanese children evolved in the 1990s with the introduction of ACE inhibitors and steroids.
  • Long-term outcomes for pediatric IgA-N in Japan have not been extensively evaluated.

Purpose of the Study:

  • To assess the long-term renal survival trends in Japanese children diagnosed with IgA nephropathy.
  • To determine if treatment advancements since the 1990s have improved outcomes for pediatric IgA-N.
  • To identify factors influencing end-stage renal disease (ESRD)-free survival in this cohort.

Main Methods:

  • Retrospective cohort study of 500 children diagnosed with IgA-N between 1976 and 2004.
  • Division of the study period into two groups: 1976-1989 and 1990-2004.
  • Kaplan-Meier analysis for actuarial renal survival and logrank test for comparisons; Cox proportional hazard model for multivariate analysis.

Main Results:

  • Overall actuarial renal survival was 96.4% at 10 years, 84.5% at 15 years, and 73.9% at 20 years.
  • Renal survival was significantly better in the 1990-2004 period compared to 1976-1989 (p=0.008).
  • A marked improvement in renal survival was observed in patients with severe IgA-N (p=0.0003), with diagnosis year being an independent predictor of ESRD-free survival.

Conclusions:

  • Long-term renal survival has significantly improved in Japanese children with IgA nephropathy since the 1990s.
  • The improved outcomes are likely associated with changes in treatment protocols, including the use of ACE inhibitors and steroids.
  • Diagnosis year is a crucial factor for predicting long-term renal outcomes in pediatric IgA-N.

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