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Shima Y, Mukaiyama H, Tanaka Y, Shimabukuro W, Nozu K, Kaito H, Tanaka R, Sako M, Iijima K, Tokuhara D, Yoshikawa N, Nakanishi K. Factors related to recurrence of proteinuria in childhood IgA nephropathy. Pediatr Nephrol 2024; 39:463-471. [PMID: 37594578 DOI: 10.1007/s00467-023-06116-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 07/09/2023] [Accepted: 07/27/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Proteinuria remission is the most significant predictive factor for kidney outcome in childhood IgA nephropathy (c-IgAN). Even if proteinuria remission can be obtained, some patients have recurrence of proteinuria in the long-term. METHODS This is a retrospective analysis of 312 cases of proteinuria remission among 538 consecutive children with biopsy-proven IgAN from 1976 to 2013. To elucidate the incidence and factors related to recurrence of proteinuria in c-IgAN, we compare clinical and pathological findings between patients with and without recurrence of proteinuria. RESULTS Among 312 patients with remission of proteinuria, 91 (29.2%) had recurrence of proteinuria within the observation period (median 8 years). Using a multivariate Cox regression analysis, significant factors associated with recurrence of proteinuria were onset age (HR 1.13 [95%CI: 1.05-1.22], P = 0.002) and presence of hematuria after proteinuria remission (HR 2.11 [95%CI: 1.30-3.45], P = 0.003). The Kaplan-Meier analysis showed significant differences in CKD G3a-G5-free survival between the patients with no-recurrence of proteinuria, recurrence of proteinuria and non-proteinuria remission (P < 0.0001, log-rank test). Kidney survival was 100% in no-recurrence of proteinuria, 92.2% in recurrence of proteinuria, and 65.6% in non-proteinuria remission at 15 years. Cox analyses adjusted by proteinuria remission showed that recurrence of proteinuria (HR 03.10e9 [95%CI: NA], P = 0.003) was a significant factor associated with progression to CKD G3a-G5 in all patients with c-IgAN. CONCLUSIONS Approximately 30% of patients with proteinuria remission had recurrence of proteinuria regardless of treatment. Both remission and recurrence of proteinuria are significant prognostic factors for kidney outcome. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Yuko Shima
- Department of Pediatrics, Wakayama Medical University, Kimiidera, Wakayama, 811-1, Japan.
| | - Hironobu Mukaiyama
- Department of Pediatrics, Wakayama Medical University, Kimiidera, Wakayama, 811-1, Japan
| | - Yu Tanaka
- Department of Pediatrics, Wakayama Medical University, Kimiidera, Wakayama, 811-1, Japan
| | - Wataru Shimabukuro
- Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Nishihara-Cho, Okinawa, Japan
| | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroshi Kaito
- Pediatric Nephrology, Hyogo Children's Hospital, Kobe, Japan
| | - Ryojiro Tanaka
- Pediatric Nephrology, Hyogo Children's Hospital, Kobe, Japan
| | - Mayumi Sako
- Division for Clinical Trials, Clinical Research Center, National Center for Child Health and Development, Tokyo, Japan
| | - Kazumoto Iijima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daisuke Tokuhara
- Department of Pediatrics, Wakayama Medical University, Kimiidera, Wakayama, 811-1, Japan
| | - Norishige Yoshikawa
- Clinical Research Center, Takatsuki General Hospital, Takatsuki City, Osaka, Japan
| | - Koichi Nakanishi
- Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Nishihara-Cho, Okinawa, Japan
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