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Kidney Week

Abstract: SA-PO437

Persistent Asymptomatic Isolated Hematuria in Children in IgA Nephropathy: Histopathological Features and Prognosis

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, hopital Necker, PARIS, France
  • Hogan, Julien, Emory University, Atlanta, Georgia, United States
  • Robert, Thomas, Assistance Publique des Hôpitaux de Marseille, Marseille, France
Background

Patients with recurrent episodes of macroscopic hematuria and persistent isolated microscopic hematuria (proteinuria<0.03g/mmol creatinuria and EGFR> 90ml/min/1.73m2) in IgA nephropathy (IgAN) does not correlate with prognosis. Early studies suggest that gross hematuria was associated with better outcome and with normal or minor abnormalities tissue on biopsy. We studied clincial and histological findings and prognosis in children with biopsy-proven with persistent isolated microscopic hematuria.

Methods

Data on 82 consecutive children were reviewed. 14 children with persistent isolated microscopic hematuria (median 11.7 years old; median of clinical follow-up 4.3 years) were reviewed. Renal biopsies were scored for Oxford classification.

Results

13 out 14 patients were male. Analysis of renal biopsies finds: Mesangial proliferation in 9 patients (64,3%), endocapillary proliferation in 7 (50%) patients and no patient have extracapillary proliferation. Focal glomerulosclerosis/adhesion was found in 8 (57.1%) patients, podocytopathic features in 1 (8.3%) patient and no patient have tubular atrophy/interstitial fibrosis. 2 (14.3%) patients received steroid therapy and 5 (35.7%) patients were treated with supportive care treatment alone (renin angiotensin system blockade (RASb)). At the last clinical follow up, no patients reach end-stage of renal disease, median eGFR was 100.9 ml/min/1.73m2 and median proteinuria 0.15 g/g.

Conclusion

In western countries, recurrent isolated microscopic hematuria is not a common indication for kidney biopsy. In our study, we show that children with recurrent episodes of macroscopic hematuria and persistent isolated microscopic hematuria does not preclude normal or minor abnormalities tissue. Renal biopsy should be proposed in children with recurrent episodes of macroscopic hematuria and persistent isolated microscopic hematuria. Mesangial and endocapillary proliferation is significantly associated with a poor long-term renal outcome and should open discussion about treatment (steroid therapy and/or RASb) even in absence of proteinuria and renal dysfunction.