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Journal of the Korean Society of Pediatric Nephrology 2003;7(1): 23-29.
소아 IgA 신병증의 예후와 관련한 임상병리학적 고찰
권재훈, 최은나, 박지민, 정현주, 이재승
1연세대학교 의과대학 소아과학교실
2연세대학교 의과대학 소아과학교실
3연세대학교 의과대학 소아과학교실
4연세대학교 의과대학 해부병리학교실
5연세대학교 의과대학 소아과학교실
A Clinicopathologipal Study on the Prognosis of IgA Nephropathy in Children
Jae-Hun Kwon, Eun-Na Choi, Jee-Min Park, Hyeun-Joo Jeung, Jae-Seung Lee
1Department of Pediatrics, Yonsei University College of Medicine
2Department of Pediatrics, Yonsei University College of Medicine
3Department of Pediatrics, Yonsei University College of Medicine
4Department of Pathology, Yonsei University College of Medicine
5Department of Pediatrics, Yonsei University College of Medicine
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ABSTRACT
Purpose : This study was performed to determine the natural history of histologically confirmed IgA nephropathy in pediatric patients who presented with hematuria and proteinuria.
Patients and Methods : We reviewed the clinical course of 57 patients diagnosed with IgA nephropathy at the age of 15 years or younger from 1981 to 2000. All patients presented with hematuria or minimal proteinuria($<40;mg/m^2/day$) and had normal renal function and blood pressure at the time of renal biopsy. Based on the clinical and pathological findings at the time of diagnosis, we sought for complications of IgA nephropathy such as heavy proteinuria(${ge}40;mg/m^2/day$), hypertension, and chronic renal failure.
Results : The mean age at presentation was $9.5{pm}2.8$ years(4 to 15 years) and 42(74%) were male. Isolated gross hematuria was observed in 20 patients(35%), microscopic hematuria in 3(5%), minimal proteinuria in 4(7%), both gross hematuria and minimal proteinuria in 15(26%), and both microscopic hematuria and minimal proteinuria in 15(26%). During a median follow-up of $7.0{pm}3.5$ years, 38(67%) had complete resolution of hematuria and proteinuria, 12(21%) had persistently abnormal urinalysis without development of adverse events. Only 7(12%) developed adverse events : 4(7%) developed severe proteinuria, 1(2%) became hypertensive, and 2(3%) developed Impaired renal function. By univariate analysis using the chisquare test, the age at presentation(>10 years)(P<0.01) and poor histological classes of the Lee or Haas classification at onset(P<0.05) were significantly correlated with adverse events, whereas sex and clinical signs at onset were less concordant.
Conclusion : We can conclude that the prognosis of IgA nephropathy diagnosed in early childhood is better and a good correlation exists between the clinical manifestations of this disease and the histological classes.
Key words: IgA nephropathy | Adverse events | Prognosis
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