PROGNOSTIC INDICATORS IN CHILDREN WITH IGA NEPHROPATHY - REPORT OF THE SOUTHWEST-PEDIATRIC-NEPHROLOGY-STUDY-GROUP

Investigators in 13 pediatric nephrology centers reviewed clinical and pathological features in 218 children and adolescents with IgA nephro pathy (IgAN), with particular emphasis on 80 patients who had follow-u p periods of at least 4 years. Potential prognostic markers in the 80 children were compared between 12 (15%) who developed end-stage renal disease (ESRD) versus 68 who did not. The relationship between clinica l and pathological features and the subsequent development of ESRD was examined using stepwise linear discriminant analysis in addition to s tandard univariate analysis. Seven variables were found to be predicti ve of ESRD: the presence of glomerular sclerotic changes, especially w hen this was associated with proliferation or sclerosis in 20% or more of the glomeruli; black race; hypertension at biopsy; proteinuria at biopsy; age at presentation; crescents; male sex. Using the resulting discriminant function, development of ESRD could be correctly predicte d in 95% of the subjects. We conclude that ESRD is more common in Amer ican children with IgAN than was realized previously. Risk factors pre viously documented in adult studies have been confirmed, especially th e presence of glomerular sclerosis, proteinuria, and hypertension.