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Are children with IgA nephropathy different from adult patients?
Baige Su1, Yuanyuan Jiang2,3, Zhihui Li4
1Department of Pediatric Nephrology, Peking University First Hospital, No. 1 Xi An Men Da Jie, Beijing, 100034, People's Republic of China.
Insights
Pediatric IgA nephropathy (IgAN) differs from adult IgAN in clinical and pathological features. Children show better remission rates with steroid treatment compared to adults.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Immunology
Background:
- Pediatric IgA nephropathy (IgAN) may exhibit distinct characteristics and treatment responses compared to adult IgAN.
- Previous studies suggest potential differences in disease presentation and management between pediatric and adult populations with IgAN.
Purpose of the Study:
- To comprehensively analyze and compare the clinical and pathological characteristics, treatment strategies, and prognosis of IgAN in children versus adults.
- To investigate potential differences in treatment efficacy, particularly steroid response, between pediatric and adult IgAN cohorts.
Main Methods:
- Analysis of two prospective cohorts: one pediatric and one adult, both managed by nephrologists.
- Comprehensive comparison of clinical data (hematuria, proteinuria, eGFR, hypertension) and pathological findings (Oxford classification scores M, S, T).
- Statistical analysis including propensity score matching to evaluate treatment outcomes, specifically complete remission of proteinuria after steroid therapy.
Main Results:
- 1015 children and 1911 adults with IgAN were analyzed.
- Children presented with more gross hematuria and higher proteinuria, while adults had lower eGFR and higher prevalence of hypertension.
- Pathological findings showed higher M1 scores in children, and higher S1 and T1-2 scores in adults. Children received more glucocorticoid treatment and demonstrated a higher likelihood of complete proteinuria remission with steroids (OR 1.87).
Conclusions:
- Significant differences exist in clinical and pathological manifestations of IgAN between children and adults.
- Children with IgAN appear to have a better response to steroid treatment, achieving higher rates of proteinuria remission compared to adults.
Background:
Previously, several studies have indicated that pediatric IgA nephropathy (IgAN) might be different from adult IgAN, and treatment strategies might be also different between pediatric IgAN and adult IgAN.
Methods:
We analyzed two prospective cohorts established by pediatric and adult nephrologists, respectively. A comprehensive analysis was performed investigating the difference in clinical and pathological characteristics, treatment, and prognosis between children and adults with IgAN.
Results:
A total of 1015 children and 1911 adults with IgAN were eligible for analysis. More frequent gross hematuria (88% vs. 20%, p < 0.0001) and higher proteinuria (1.8 vs. 1.3 g/d, p < 0.0001) were seen in children compared to adults. In comparison, the estimated glomerular filtration rate (eGFR) was lower in adults (80.4 vs. 163 ml/min/1.73 m2, p < 0.0001). Hypertension was more prevalent in adult patients. Pathologically, a higher proportion of M1 was revealed (62% vs. 39%, p < 0.0001) in children than in adults. S1 (62% vs. 28%, p < 0.0001) and T1-2 (34% vs. 8%, p < 0.0001) were more frequent in adults. Adjusted by proteinuria, eGFR, and hypertension, children were more likely to be treated with glucocorticoids than adults (87% vs. 45%, p < 0.0001). After propensity score matching, in IgAN with proteinuria > 1 g/d, children treated with steroids were 1.87 (95% CI 1.16-3.02, p = 0.01) times more likely to reach complete remission of proteinuria compared with adults treated with steroids.
Conclusions:
Children present significantly differently from adults with IgAN in clinical and pathological manifestations and disease progression. Steroid response might be better in children.
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