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[Clinical course and treatment results of IgA nephropathy in children]
M Sieniawska1, D Kozak-Białasik, C Gura
1Katedra i Klinika Pediatrii i Nefrologii Akademii Medycznej w Warszawie.
Insights
This study followed 27 children with IgA nephropathy for over 9 years. Treatment outcomes varied, with some showing improvement and others developing chronic kidney disease and hypertension.
Area of Science:
- Pediatric Nephrology
- Immunology
- Clinical Medicine
Context:
- IgA nephropathy (IgAN) is a common cause of glomerulonephritis in children.
- Long-term outcomes and treatment responses in pediatric IgAN are not fully understood.
- This study investigates the clinical course and treatment effects in a cohort of children with IgAN.
Purpose:
- To analyze the clinical course of IgA nephropathy in children.
- To evaluate the effectiveness of various treatments, including anticoagulants, corticosteroids, and alkylating agents.
- To correlate pathomorphological findings with clinical presentation and treatment outcomes.
Summary:
- Twenty-seven children with IgAN were observed for a mean of 9.1 years.
- Clinical course was classified into four groups based on urinary changes, related to WHO pathomorphological types.
- Hypertension and acute renal failure were noted in most groups. Treatment responses varied: 6 children showed urine changes regression, 12 had decreased hematuria/proteinuria, and 3 of 8 with nephrotic syndrome progressed to chronic renal failure/end-stage renal disease.
Impact:
- Provides insights into the long-term prognosis of IgA nephropathy in children.
- Highlights the challenges in managing hypertension and renal failure in pediatric IgAN.
- Informs treatment strategies by correlating pathomorphology with clinical outcomes.
Abstract:
The clinical course as well as the effects of the treatment in 27 children suffering from IgA nephropathy were followed in this study. The observation period lasted from 1.5 to 15.5 years, mean 9.1. The clinical picture according to changes in urine was the criterion of classification into 4 groups, and was related to the WHO classification of pathomorphological types. Hypertension as well as acute renal failure were observed in each clinical group except the group of children with erythrocyturia and/or haematuria. Depending on the pathomorphological changes in kidneys, different groups of drugs were used, e.g. anticoagulants, corticosteroids and also alkylating agents. In 9 children no treatment was prescribed. Only 6 children showed regression of urine changes: 2 of them with steroid-sensitive nephrotic syndrome and 1 with steroid-resistant nephrotic syndrome. In 12 children, erythrocyturia and proteinuria decreased and the intervals between successive seizures of haematuria became longer. In 3 of 8 children with nephrotic syndrome, chronic renal failure as well as end-stage renal disease were observed. In 2 of them hypertension was present during the entire observation period and it was difficult to achieve control using hypotensive drugs. In the remaining 2 children, regression of nephrotic syndrome was found, but slight proteinuria and hypertension are observed.