IGA NEPHROPATHY - LONG-TERM PROGNOSIS FOR PEDIATRIC-PATIENTS

Objective: The determination of the ultimate prognosis for patients wi th IgA nephropathy diagnosed in childhood requires long-term follow-up of identified patients. The purpose of this study was to obtain such follow-up for patients from two centers where the disease has been dia gnosed for more than 20 years. Methods: Clinical data at the apparent onset of symptoms and renal histologic data were obtained for 103 pati ents in whom IgA nephropathy was diagnosed before age 18 years. Clinic al status at last follow-up was obtained from office records or from d irect contact with the patient. Predicted kidney survival was determin ed by the Kaplan-Meier method. Follow-up of more than 10 years from th e time of biopsy was available for 40 of the patients. Results: Fourte en of the patients have progressed to end-stage renal disease; three o thers have progressive chronic renal insufficiency as defined by an es timated creatinine clearance of less than 50 ml/min per 1.73 m(2). Sev erity of the renal histologic findings and the degree of proteinuria a t the time of biopsy were associated with poor outcome. For all patien ts, predicted kidney survival from the time of apparent onset was 94% at 5 years, 87% at 10 years, 82% at 15 years, and 70% at 20 years. Age at clinical onset and gender were not associated with poor outcome, b ut black race and severity of renal histologic findings were. Conclusi on: With fellow-up into adulthood, the outcome for pediatric patients with IgA nephropathy appears to be as serious as that reported in adul t patients. Follow-up of a pediatric patient with persistent clinical findings should be maintained after the patient's care is transferred to a physician caring for adults.