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Journal of the Korean Society of Pediatric Nephrology 2010;14(2): 154-165. doi: https://doi.org/10.3339/jkspn.2010.14.2.154
소아 IgA 신병증의 장기 추적(평균 10.8년)에 따른 임상 경과 및 병리학적 변화
문창민, 김병길, 임범진, 송지선, 정현주
1관동대학교 의과대학 소아과학교실
2관동대학교 의과대학 소아과학교실
3연세대학교 의과대학 병리학교실
4관동대학교 의과대학 병리학교실
5연세대학교 의과대학 병리학교실
Clinicopathologic Changes of IgA Nephropathy in Children During Long-term (average 10.8 yrs) Follow-up
Chang-Min Moon, Pyung-Kil Kim, Beom-Jin Lim, Ji-Sun Song, Hyeon-Joo Jeong
1Department of Pediatrics, Kwandong University, College of Medicine
2Department of Pediatrics, Kwandong University, College of Medicine
3Department of Pathology, Yonsei University, College of Medicine
4Department of Pathology, Kwandong University, College of Medicine
5Department of Pathology, Yonsei University, College of Medicine
Received: September 20, 2010;  Revised: October 5, 2010.  Accepted: October 8, 2010.
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ABSTRACT
Purpose : We know little about the natural course of IgA nephropathy (IgAN) in association with histologic changes especially in children. We investigated clinicopathologic features with long-term follow-up biopsy to clarify the outcomes and prognostic indicators for childhood IgAN.
Methods : From our patients' medical records, we retrieved 20 patients with IgAN, to whom renal biopsies had been performed for the initial diagnosis and follow-up to find out any histologic changes. Initial and follow-up biopsies were classified by Haas classification. The changes of these parameters were compared with the evolution of clinical features.
Results : Patients were treated with angiotensin-converting enzyme inhibitors in combination with angiotensin receptor blockers (in subclass II or above) and short-term cyclosporine A(in patients showing nephrotic syndrome). Histologic improvement in 7 cases and deterioration in 3 cases were observed. At the time of last biopsy, 10 cases (50%) showed clinical remission and the others showed improved clinical features. These clinical outcomes did not correlate with initial Haas classifications. Hypertension at onset observed in 5 cases (25%) revealed significant correlation with clinical outcome (P =0.01) and last Haas classification (P =0.007). None of the cases showed progression to CRF or ESRD.
Conclusion : During a mean follow-up of $10.8{pm}3.4$ years, childhood IgAN showed good clinicopathologic outcome. Hypertension at onset was only a strong predictor of clinicopathologic outcomes, but initial Haas classification cannot predict outcomes in children. Histologic change of IgAN in long term follow-up period cannot be completely predicted by clinical data and vice versa. Therefore, a renal biopsy should be considered as a part of follow-up plan.
Key words: IgA nephropathy | Children | Haas classification | Prognosis
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