Factors related to recurrence of proteinuria in childhood IgA nephropathy.

Yuko Shima, Hironobu Mukaiyama, Yu Tanaka, Wataru Shimabukuro, Kandai Nozu, Hiroshi Kaito, Ryojiro Tanaka, Mayumi Sako, Kazumoto Iijima, Daisuke Tokuhara, Norishige Yoshikawa, Koichi Nakanishi

Pediatric nephrology (Berlin, Germany) 2024 Feb

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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. 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. 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. 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. © 2023. The Author(s), under exclusive licence to International Pediatric Nephrology Association.

Citation

Yuko Shima, Hironobu Mukaiyama, Yu Tanaka, Wataru Shimabukuro, Kandai Nozu, Hiroshi Kaito, Ryojiro Tanaka, Mayumi Sako, Kazumoto Iijima, Daisuke Tokuhara, Norishige Yoshikawa, Koichi Nakanishi. Factors related to recurrence of proteinuria in childhood IgA nephropathy. Pediatric nephrology (Berlin, Germany). 2024 Feb;39(2):463-471