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[Glomerular ultrastructures and prognosis of the patients with urinary abnormalities found by school screening
K Yanase1, K Kaneda, Y Y Chiang
1Second Department of Pathology, Fukuoka University, Japan.
Insights
School screening identified IgA nephropathy (IgAN) and thin membrane disease (TMD) in children. Most cases showed minor abnormalities, with no progression to renal insufficiency during follow-up.
Area of Science:
- Pediatric Nephrology
- Renal Pathology
- Glomerular Diseases
Context:
- School screening programs are crucial for early detection of kidney diseases in children.
- Histopathological analysis of serial renal biopsies provides insight into disease progression and outcomes.
- Understanding the clinical features and biopsy findings in pediatric kidney disease is essential for management.
Purpose:
- To investigate the histopathological findings and clinical features of kidney diseases detected through school screening in children.
- To compare the frequency, severity, and outcomes of IgA nephropathy (IgAN), thin membrane disease (TMD), and normal renal biopsies.
- To assess the long-term renal outcomes in children diagnosed with various glomerular abnormalities.
Summary:
- A detailed histopathological study of 120 children identified IgA nephropathy (34.2%), thin membrane disease (21.7%), and normal glomeruli (18.3%) as common findings from school screening.
- Minor glomerular abnormalities were prevalent (67.5%), with TMD, normal findings, and IgAN comprising the majority.
- Proteinuria was more frequent and severe in IgAN compared to TMD and normal findings, while hematuria was greater in normal findings than IgAN.
Impact:
- The study highlights the effectiveness of school screening in detecting pediatric kidney diseases.
- It demonstrates a favorable prognosis for most children, with no cases progressing to renal insufficiency and a significant percentage showing resolution of urinary abnormalities.
- Findings contribute to the understanding of IgAN and TMD in children and inform clinical management strategies.
Abstract:
Detailed histopathological study were performed and compared with clinical features in 120 children with serial renal biopsies who were found by school screening program. 41 cases (34.2%) of IgA nephropathy (IgAN), 26 cases (21.7%) of thin membrane disease (TMD) and 22 cases (18.3%) of normal glomeruli [( Normal]) accounted for 74.2% of all biopsies. 81 cases (67.5%) were revealed to be minor glomerular abnormalities by light microscopy and which contained 26 cases (32.1%) of TMD, 22 cases (27.2%) of [Normal] and 19 cases (23.4%) of IgAN. The frequency and the severity of proteinuria was significantly higher in IgAN than in TMD and [Normal] (P less than 0.01, P less than 0.05). Hematuria was significantly greater in [Normal] than in IgAN. In the 71 follow-up cases, no patient went to renal insufficiency, moreover, urinary abnormalities had disappeared in 25.4% of the patients including IgAN, TMD, [Normal], nonIgA proliferative glomerulonephritis, incomplete foot process disease and MPGN. [Normal] consisted of stationary or exercised urinary abnormality.