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Abstract: SA-PO589

Significance of Remission of Proteinuria in Childhood IgA Nephropathy

Session Information

  • Pediatric Nephrology - II
    November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1800 Pediatric Nephrology

Authors

  • Shima, Yuko, Wakayama Kenritsu Ika Daigaku, Wakayama, Wakayama, Japan
  • Mukaiyama, Hironobu, Wakayama Kenritsu Ika Daigaku, Wakayama, Wakayama, Japan
  • Tanaka, Yu, Wakayama Kenritsu Ika Daigaku, Wakayama, Wakayama, Japan
  • Shimabukuro, Wataru, Ryukyu Daigaku Igakubu Daigakuin Igaku Kenkyuka, Nakagami-gun, Okinawa, Japan
  • Kaito, Hiroshi, Hyogo Kenritsu Kodomo Byoin, Kobe, Hyogo, Japan
  • Tanaka, Ryojiro, Hyogo Kenritsu Kodomo Byoin, Kobe, Hyogo, Japan
  • Nozu, Kandai, Kobe Daigaku, Kobe, Hyogo, Japan
  • Iijima, Kazumoto, Kobe Daigaku, Kobe, Hyogo, Japan
  • Tokuhara, Daisuke, Wakayama Kenritsu Ika Daigaku, Wakayama, Wakayama, Japan
  • Yoshikawa, Norishige, Shakai Iryo Hojin Aijinkai Takatsuki Byoin, Takatsuki, Osaka, Japan
  • Nakanishi, Koichi, Ryukyu Daigaku Igakubu Daigakuin Igaku Kenkyuka, Nakagami-gun, Okinawa, Japan
Background

Remission of proteinuria is the most significant prognostic factor for kidney outcome in IgA nephropathy (IgAN). There is no study investigating the effect of proteinuria remission on long-term outcomes in a large cohort of pediatric IgA nephropathy. The purpose of this study is to clarify the factors for proteinuria remission and their outcomes in childhood IgAN.

Methods

In the retrospective analysis of 538 biopsy-proven childhood IgAN between 1976 and 2013, we evaluated clinical and pathological findings of the 309 cases (57.4%) with proteinuria remission and the others.

Results

Although there were significant differences in onset age (median 10.3 vs. 11.9 years, p<0.0001), and follow-up period (median 7 vs. 3 years, p<0.0001) between the proteinuria remission and non-remission groups, there was no other significant difference in clinical and pathological findings. In the logistic regression analyses, onset age (OR=0.90, p=0.04), initial biopsy year before 1990 (OR=0.41, p=0.03), need for immunosuppressive treatment (OR=0.40, p=0.03), and follow-up period (OR=1.21, p<0.0001) were significantly related to proteinuria remission. Kaplan-Meier analysis showed a significantly better kidney survival rate in the proteinuria remission group than in the non-proteinuria remission group (97.0 vs 78.7% at 13 years, p<0.001). And, all patients who progressed to kidney failure in the proteinuria remission group had proteinuria relapse.

Conclusion

The patients with childhood IgAN were detected by annual school screening early in the disease course in Japan and they were treated according to their clinical and pathological severity. Regardless of clinical and pathological severity at biopsy, risk factors related to proteinuria remission were only onset age, the initial biopsy year before 1990 when extensive treatments began, and the need for immunosuppressive treatment in the course. Not only proteinuria remission but also the continuation of proteinuria remission is important for renal survival.