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Clinical and histological differences between adults and children in new onset IgA nephropathy

Alexandra Cambier1, Marion Rabant2, Khalil El Karoui3

  • 1Service de néphrologie pédiatrique, APHP, Hôpital Universitaire Robert-Debré, 48 Boulevard Serrurier, 75019, Paris, France. alexandra.cambier@aphp.fr.

Pediatric Nephrology (Berlin, Germany)
|May 24, 2020
PubMed

Insights

Children with IgA nephropathy (IgAN) show higher eGFR and more proliferative lesions, while adults present with more chronic damage. Histological assessment is crucial for understanding disease presentation in IgAN patients.

Area of Science:

  • Nephrology
  • Pediatric Nephrology
  • Immunology

Background:

  • IgA nephropathy (IgAN) presentation differs between children and adults.
  • No prior systematic comparison of pediatric vs. adult IgAN clinical, biological, and histological features exists.

Purpose of the Study:

  • To systematically compare clinical and histological characteristics of childhood-onset IgAN with adult-onset IgAN.
  • To identify differences in disease presentation and response to treatment between pediatric and adult IgAN patients.

Main Methods:

  • Retrospective review of 211 IgAN patients (82 children, 129 adults) from two Paris centers.
  • Kidney biopsies analyzed for Oxford classification and podocytopathic (P1) features.
  • Comparison of clinical and histological data at diagnosis and after steroid treatment.

Main Results:

  • Children had higher eGFR (89.5 vs. 64 ml/min/1.73 m²), while proteinuria levels were similar.
  • Pediatric IgAN showed more mesangial (M1) and endocapillary (E1) hypercellularity.
  • Adults had more focal glomerulosclerosis (S1), tubular atrophy/fibrosis (T1), and P1 features.
  • Proteinuria associated with proliferative lesions (M1, E1, C1) in children, and chronic lesions (S1, P1, T1) in adults.
  • Steroid treatment improved proteinuria in both groups, with eGFR increasing in children and remaining stable in adults.

Conclusions:

  • Proteinuria in pediatric IgAN indicates glomerular proliferative lesions.
  • Proteinuria in adult IgAN often signifies chronic lesions, necessitating histological evaluation.
  • Distinct clinical and histological profiles of IgAN in children and adults underscore the need for tailored diagnostic and therapeutic approaches.
Abstract

Keywords:
AdultsChildrenIgA nephropathyKidney biopsyOxford classificationPresentationPrimary glomerulonephritis

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