Are children with IgA nephropathy different from adult patients?

被引：6

作者：

Su, Baige ^{[1
]}

Jiang, Yuanyuan ^{[2
,3
]}

Li, Zhihui ^{[4
]}

Zhou, Jianhua ^{[5
]}

Rong, Liping ^{[6
]}

Feng, Shipin ^{[7
]}

Zhong, Fazhan ^{[8
]}

Sun, Shuzhen ^{[9
]}

Zhang, Dongfeng ^{[10
]}

Xia, Zhengkun ^{[11
]}

Feng, Chunyue ^{[12
]}

Huang, Wenyan ^{[13
]}

Li, Xiaoyan ^{[14
]}

Chen, Chaoying ^{[15
]}

Hao, Zhihong ^{[16
]}

Wang, Mo ^{[17
]}

Qin, Li ^{[18
]}

Chen, Minguang ^{[19
,20
]}

Li, Yuanyuan ^{[21
,22
]}

Ding, Juanjuan ^{[23
]}

Bao, Ying ^{[24
]}

Liu, Xiaorong ^{[25
]}

Deng, Fang ^{[26
]}

Cheng, Xueqin ^{[27
]}

Zhang, Li ^{[28
]}

Zhang, Xuan ^{[29
]}

Yang, Huandan ^{[30
]}

Peng, Xiaojie ^{[31
]}

Sun, Qianliang ^{[4
]}

Deng, Linxia ^{[5
]}

Jiang, Xiaoyun ^{[6
]}

Xie, Min ^{[7
]}

Gao, Yan ^{[8
]}

Yu, Lichun ^{[9
]}

Liu, Ling ^{[10
]}

Gao, Chunlin ^{[11
]}

Mao, Jianhua ^{[12
]}

Zheng, Weihua ^{[13
]}

Dang, Xiqiang ^{[14
]}

Xia, Hua ^{[15
]}

Wang, Yujie ^{[32
]}

Zhong, Xuhui ^{[1
]}

Ding, Jie ^{[1
]}

Lv, Jicheng ^{[2
]}

Zhang, Hong ^{[2
]}

机构：

[1] Peking Univ First Hosp, Dept Pediat Nephrol, 1 Xi An Men Da Jie, Beijing 100034, Peoples R China

[2] Peking Univ First Hosp, Renal Div, 8 Xi Shi Ku Da Jie, Beijing 100034, Peoples R China

[3] Capital Med Univ, Beijing Hosp Tradit Chinese Med, Dept Nephrol, Beijing, Peoples R China

[4] Hunan Childrens Hosp, Dept Nephrol Rheumatol & Immunol, Changsha, Hunan, Peoples R China

[5] Huazhong Univ Sci & Technol, Tongji Hosp, Tongji Med Coll, Dept Pediat, Wuhan 430030, Hubei, Peoples R China

[6] Sun Yat Sen Univ, Affiliated Hosp 1, Dept Pediat Nephrol & Rheumatol, Guangzhou, Peoples R China

[7] Univ Elect Sci & Technol China, Chengdu Womens & Childrens Cent Hosp, Sch Med, Dept Pediat Nephrol, Chengdu 611731, Peoples R China

[8] Guangzhou Med Univ, Guangzhou Women & Childrens Med Ctr, Pediat Nephrol Dept, Guangzhou 510623, Guangdong, Peoples R China

[9] Shandong Univ, Shandong Prov Hosp, Cheeloo Coll Med, Dept Pediat Nephrol & Rheumatism & Immunol, Jinan 250021, Peoples R China

[10] Childrens Hosp Hebei Prov, Nephrol & Immunol Dept, Shijiazhuang, Hebei, Peoples R China

[11] Nanjing Univ, Jinling Hosp, Med Sch, Dept Pediat, Nanjing, Peoples R China

[12] Zhejiang Univ, Sch Med, Childrens Hosp, Dept Nephrol, Hangzhou, Peoples R China

[13] Shanghai Jiao Tong Univ, Shanghai Childrens Hosp, Sch Med, Dept Nephrol & Rheumatol, Shanghai, Peoples R China

[14] Cent South Univ, Xiangya Hosp 2, Dept Pediat, Changsha, Peoples R China

[15] Capital Inst Pediat, Dept Nephrol, Childrens Hosp, Beijing, Peoples R China

[16] South China Univ Technol, Guangzhou Peoples Hosp 1, Dept Pediat, Affiliated Hosp 2, Guangzhou, Peoples R China

[17] Chongqing Med Univ, Childrens Hosp, Dept Nephrol, Chongqing, Peoples R China

[18] Kunming Sci & Technol Univ, Peoples Hosp Yunnan Prov 1, Affiliated Hosp, Dept Pediat, Kunming, Peoples R China

[19] Wenzhou Med Univ, Affiliated Hosp 2, Dept Pediat Nephrol, Wenzhou, Peoples R China

[20] Wenzhou Med Univ, Yuying Childrens Hosp, Wenzhou, Peoples R China

[21] Fujian Med Univ, Fuzong Clin Med Coll, Dept Pediat, Fuzhou 350025, Peoples R China

[22] Fujian Childrens Hosp, Dept Nephrol Rheumatol & Immunol, Fuzhou 350014, Peoples R China

[23] Huazhong Univ Sci & Technol, Wuhan Childrens Hosp, Wuhan Maternal & Child Healthcare Hosp, Dept Pediat Nephrol,Tongji Med Coll, Wuhan 430016, Hubei, Peoples R China

[24] Xian Childrens Hosp, Dept Nephrol, Xian, Shaanxi, Peoples R China

[25] Capital Med Univ, Beijing Childrens Hosp, Dept Pediat Nephrol, Beijing, Peoples R China

[26] Anhui Prov Childrens Hosp, Dept Nephrol, Hefei, Peoples R China

[27] Nanjing Med Univ, Dept Nephrol, Childrens Hosp, Nanjing, Peoples R China

[28] First Hosp Jilin Univ, Dept Pediat Nephrol, Changchun, Peoples R China

[29] Tianjin Childrens Hosp, Dept Gen Med, Tianjin, Peoples R China

[30] Xuzhou Med Univ, Xuzhou Childrens Hosp, Dept Nephrol, Xuzhou, Peoples R China

[31] Jiangxi Prov Childrens Hosp, Dept Neurol, Nanchang 330006, Peoples R China

[32] Tsinghua Univ, Beijing Tsinghua Changgung Hosp, Med Data Sci Ctr, Med Res Ctr,Sch Clin Med, Beijing, Peoples R China

来源：

PEDIATRIC NEPHROLOGY | 2024年 / 39卷 / 08期

关键词：

IgA nephropathy; Children; Adults; Steroid; Remission of proteinuria; OXFORD CLASSIFICATION; DISEASES;

D O I：

10.1007/s00467-024-06361-1

中图分类号：

R72 [儿科学];

学科分类号：

100202 ;

摘要：

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 m(2), 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.

引用

页码：2403 / 2412

页数：10

共 34 条

[1] The MEST score provides earlier risk prediction in IgA nephropathy [J].

Barbour, Sean J. ;

Espino-Hernandez, Gabriela ;

Reich, Heather N. ;

Coppo, Rosanna ;

Roberts, Ian S. D. ;

Feehally, John ;

Herzenberg, Andrew M. ;

Cattran, Daniel C. .

KIDNEY INTERNATIONAL, 2016, 89 (01) :167-175

[2] Clinical and histological differences between adults and children in new onset IgA nephropathy [J].

Cambier, Alexandra ;

Rabant, Marion ;

El Karoui, Khalil ;

Peuchmaur, Michel ;

Servais, Aude ;

Hertig, Alexandre ;

Deschenes, Georges ;

Salomon, Remi ;

Hogan, Julien ;

Robert, Thomas .

PEDIATRIC NEPHROLOGY, 2020, 35 (10) :1897-1905

[3] Immunosuppressive Treatment in Children With IgA Nephropathy and the Clinical Value of Podocytopathic Features [J].

Cambier, Alexandra ;

Rabant, Marion ;

Peuchmaur, Michel ;

Hertig, Alexandre ;

Deschenes, Georges ;

Couchoud, Cecile ;

Kolko, Anne ;

Salomon, Remi ;

Hogan, Julien ;

Robert, Thomas .

KIDNEY INTERNATIONAL REPORTS, 2018, 3 (04) :916-925

[4] Changing prevalence of glomerular diseases in Korean adults: a review of 20 years of experience [J].

Chang, Jae Hyun ;

Kim, Dong Ki ;

Kim, Hyun Wook ;

Park, Sun Young ;

Yoo, Tae-Hyun ;

Kim, Beom Seok ;

Kang, Shin-Wook ;

Choi, Kyu Hun ;

Han, Dae-Suk ;

Jeong, Heon Joo ;

Lee, Ho Yung .

NEPHROLOGY DIALYSIS TRANSPLANTATION, 2009, 24 (08) :2406-2410

[5] IgA nephropathy in children and in adults: two separate entities or the same disease? [J].

Coppo, Rosanna ;

Robert, Thomas .

JOURNAL OF NEPHROLOGY, 2020, 33 (06) :1219-1229

[6] Pediatric IgA Nephropathy in Europe [J].

Coppo, Rosanna .

KIDNEY DISEASES, 2019, 5 (03) :182-188

[7] Validation of the Oxford classification of IgA nephropathy in cohorts with different presentations and treatments [J].

Coppo, Rosanna ;

Troyanov, Stephan ;

Bellur, Shubha ;

Cattran, Daniel ;

Cook, H. Terence ;

Feehally, John ;

Roberts, Ian S. D. ;

Morando, Laura ;

Camilla, Roberta ;

Tesar, Vladimir ;

Lunberg, Sigrid ;

Gesualdo, Loreto ;

Emma, Francesco ;

Rollino, Cristiana ;

Amore, Alessandro ;

Praga, Manuel ;

Feriozzi, Sandro ;

Segoloni, Giuseppe ;

Pani, Antonello ;

Cancarini, Giovanni ;

Durlik, Magalena ;

Moggia, Elisabetta ;

Mazzucco, Gianna ;

Giannakakis, Costantinos ;

Honsova, Eva ;

Sundelin, B. Brigitta ;

Di Palma, Anna Maria ;

Ferrario, Franco ;

Gutierrez, Eduardo ;

Asunis, Anna Maria ;

Barratt, Jonathan ;

Tardanico, Regina ;

Perkowska-Ptasinska, Agnieszka .

KIDNEY INTERNATIONAL, 2014, 86 (04) :828-836

[8] The Oxford IgA nephropathy clinicopathological classification is valid for children as well as adults [J].

Coppo, Rosanna ;

Troyanov, Stephan ;

Camilla, Roberta ;

Hogg, Ronald J. ;

Cattran, Daniel C. ;

Cook, H. Terence ;

Feehally, John ;

Roberts, Ian S. D. ;

Amore, Alessandro ;

Alpers, Charles E. ;

Barratt, Jonathan ;

Berthoux, Francois ;

Bonsib, Stephen ;

Bruijn, Jan A. ;

D'Agati, Vivette ;

D'Amico, Giuseppe ;

Emancipator, Steven N. ;

Emma, Francesco ;

Ferrario, Franco ;

Fervenza, Fernando C. ;

Florquin, Sandrine ;

Fogo, Agnes B. ;

Geddes, Colin C. ;

Groene, Hermann J. ;

Haas, Mark ;

Herzenberg, Andrew M. ;

Hill, Prue A. ;

Hsu, Stephen I. ;

Jennette, J. Charles ;

Joh, Kensuke ;

Julian, Bruce A. ;

Kawamura, Tetsuya ;

Lai, Fernand M. ;

Li, Lei S. ;

Li, Philip K. ;

Liu, Zhi H. ;

Mezzano, Sergio ;

Schena, F. Paolo ;

Tomino, Yasuhiko ;

Walker, Patrick D. ;

Wang, Haiyan ;

Weening, Jan J. ;

Yoshikawa, Norishige ;

Zhang, Hong .

KIDNEY INTERNATIONAL, 2010, 77 (10) :921-927

[9]

Flynn JT, 2017, PEDIATRICS, V140, DOI [10.1542/peds.2017-3035, 10.1542/peds.2017-1904]

[10] Long-term follow-up of an IgA nephropathy cohort: outcomes and risk factors [J].

Gadola, Liliana ;

Cabrera, Maria Jimena ;

Garau, Mariela ;

Coitino, Ruben ;

Aunchayna, Maria Haydee ;

Noboa, Oscar ;

Alvarez, Maria Asuncion ;

Balardini, Sylvia ;

Desiderio, Graciela ;

Dibello, Nelson ;

Ferreiro, Alejandro ;

Giro, Soledad ;

Luzardo, Leonella ;

Maino, Alfredo ;

Orihuela, Lucia ;

Ottati, Maria Gabriela ;

Urrestarazu, Andres .

RENAL FAILURE, 2023, 45 (01)

← 1 2 3 4 →