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Abstract: SA-PO439

Clinical and Histological Differences Between Adults and Children in New Onset IgA Nephropathy

Session Information

  • Pediatric Nephrology - II
    October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1600 Pediatric Nephrology

Authors

  • Alexandra, Cambier, Robert Debré hospital, Paris, France
  • Rabant, Marion, NECKER Hospital, PARIS, France
  • Peuchmaur, Michel, APHP Université Diderot Paris7, Paris, France
  • Hertig, Alexandre, Sorbonne University, Paris, France
  • Deschênes, Georges, Hospital Robert Debre/Pediatric Nephrology, Paris, France
  • Salomon, Remi, NECKER Hospital, PARIS, France
  • Hogan, Julien, Emory University, Atlanta, Georgia, United States
  • Robert, Thomas, Assistance Publique des Hôpitaux de Marseille, Marseille, France
Background

Recent studies showed that prognosis of children IgAN could be as severe as adults but would manifest differently. We addressed this question comparing clinical and histological characteristics at diagnostic of IgAN between children and adult.

Methods

Data on 211 consecutive patients, including 82 children and 129 adults were reviewed. Renal biopsies were scored for Oxford classification and podocytopathic features.

Results

Estimated glomerular filtration (eGFR) and serum albumin at diagnostic was lower in adults compared to children (64 vs 89.5 ml/min/1,73m2; p=0.0001) and (3.4 vs 3.8g/dl, p=0.0001). Serum albumin was lower in children compared to adults (3.4 vs 3.8g/dl, p=0.0001) while proteinuria was not different. Histological analysis of kidney biopsy finds higher proportion of mesangial (M1) and endocapillary (E1) proliferation in children compared to adult (M1 (80.7% vs 27.9% p=0.0001); E1 (71.3% vs 30% p=0.0001). Focal glomerulosclerosis (S1), tubular atrophy/interstitial fibrosis ≥ 25% (T1) and podocytopathic features (P1) were higher in adult, (S1 (81.5% vs 61.3% p=0.0012), T1 (49.5% vs 1.35% p=0.0001), P1 (33.8% vs 16.4% p=0.007)). Proteinuria was associated with M1, E1 and C1 in children (M1, p=0.001; E1, p=0.0005; C1, p=0.0014) whereas proteinuria was associated with S1, P1 and T1 in adult ( S1, p=0.0001; P1, p=0.0001; T1, p=0.001). After steroid treatment, proteinuria decreased in children (1.54 (0.9–3.6) to 0.03 (0.2–0.7)g/g, p<0.001) and in adult group (1.31 (0.77–2.2) to 0.4 (0.2–1)g/g, p<0.001). eGFR remain stable in adult (41.4 to 36.9 ml/min/1.73m2) and increase significantly in children (98.6 to 109,3 ml/min/1.73m2) between M0 and last follow-up.

Conclusion

In children IgAN, proteinuria is related to glomerular proliferative lesions whereas in adult proteinuria is related to chronic lesions. Steroid would be more effectiveness on eGFR and proteinuria in children due to the steroid sensitivity of glomerular lesion .