Study for Clinical Indicators of Prediction for Histological Finding of IgA Nephropathy

Han, Byong-Mu; Cho, Jin-Youl; Chuon, Ko-Woon; NamGoong, Mee-Kyung

J Korean Soc Pediatr Nephrol > Volume 7(2); 2003 > Article

J Korean Soc Pediatr Nephrol 2003;7(2): 150-156.

IgA 신병증의 조직소견을 예측할 수 있는 임상지표에 관한 연구

한병무, 조진열, 전고운, 남궁미경

¹연세대학교 원주의과대학 소아과학교실
²연세대학교 원주의과대학 소아과학교실
³연세대학교 원주의과대학 소아과학교실
⁴연세대학교 원주의과대학 소아과학교실

Study for Clinical Indicators of Prediction for Histological Finding of IgA Nephropathy

Byong-Mu Han, Jin-Youl Cho, Ko-Woon Chuon, Mee-Kyung NamGoong

¹Department of Pediatrics, Yonsei University Wonju College of Medicine
²Department of Pediatrics, Yonsei University Wonju College of Medicine
³Department of Pediatrics, Yonsei University Wonju College of Medicine
⁴Department of Pediatrics, Yonsei University Wonju College of Medicine

ABSTRACT

Purpose : Efforts to predict the clinicopathological outcome of IgA nephropathy have been made but have yielded conflicting results and have not helped in deciding the appropriate timing of the renal biopsy. In this study, we reviewed the predictive factors of clinicopathological outcome for finding out the criteria of renal biopsy timing of IgA nephropathy.
Methods : Forty children diagnosed with biopsy proven IgA nephropathy at Wonju Christian Hospital were studied retrospectively, based on medical records.
Results : Among 39 patients, 2 children progressed to higher serum creatinine level. One of them reached to the end stage renal disease within 2 year 7 months. According to WHO histopathological classification, there were 15 cases of class I, 14 cases of class II, 7 cases of class III, and 3 cases of class IV. In the mild histological classes(class I, II), gross hematuria was shown in 23 out of 29 children(P=0.02). In the severe histological classes(class III, IV), gross hematuria was noted in 4 out of 10(P>0.05). The tubulointerstitial changes were grade 1 in 24 cases, grade 2 in 4 cases, grade 3 in 8 cases, and grade 4 in 3 cases. With an increase in the tubulointerstitial grade, the 24 hour urine protein/albumin ratio increased. Serum creatinine less than 0.79 mg/dL could predict the lower grade(grade 1 and 2) of tubulointerstitial changes. But serum creatinine greater than 1.13 mg/dL could predict the higher grade(grade 3 and 4) of tubulointerstitial changes. In children with gross hematuria(n=27), serum creatinine was lower(0.78 vs 1.09 mg/dL, P=0.027), serum IgA was higher(316.3 vs 198.8 mg/dL), and the cases of lower WHO classification(I and II) were more common(23 vs 4, P=0.029) than the children with microscopic hematuria.
Conclusion : Serum creatinine less than 0.79 mg/dL, macroscopic hematuria, and higher 24 hour urine protein/albumin ratio would predict the lower grade glomerulo tubulointerstitial lesion in IgA nephropathy and could be used as the criteria delaying the renal biopsy.

Key words: IgA nephropathy | Renal biopsy timing