ESPN 54th Annual Meeting

ESPN 2022


 
IGAN IN CHILDREN: A RETROSPECTIVE SINGLE CENTER STUDY
LUCA ANTONUCCI 1 LAURA FUIANO 1 BARBARA RUGGIERO 1 ALESSANDRA GIANVITI 1 MARINA VIVARELLI 1 FRANCESCA DIOMEDI-CAMASSEI 1 FRANCESCO EMMA 1

1- BAMBINO GESù CHILDREN HOSPITAL
 
Introduction:

IgA nephropathy (IgAN) is the most common glomerulonephritis in childhood. Long-term outcome is generally good, but the risk of progression is about 20-30% at 20 years from onset. Disease course is variable and difficult to predict, ranging from spontaneous remission to rapid progression. Most pediatric studies have focused on identifying risk factors of progression. Conversely, few data exist on IgAN remission. Our study aimed to identify the probability of a complete clinical remission of pediatric IgAN and its predictive factors. 

Material and methods:

In our monocentric retrospective study, we selected all IgAN histological confirmed cases from 1986 to 2018. The biopsy were reclassified according to MEST-C score of Oxford classification. Complete clinical remission was defined as absence of proteinuria, hematuria, hypertension, renal failure, in patients off therapy for more than 1 year. The Kaplan-Meier method and Cox proportional hazard model were used for the analysis. 

Results:

A total of 153 patients were enrolled, with an age at onset of 10.6±4 years. At biopsy, prevalence of proliferative lesions (M 41%, E 18%, C 19%) was higher compared to chronic ones (S 32%, T 4%). The estimated probability of complete remission was about 40% at 10 years of follow-up. The probability of recurrence at 6 years from remission was about 20%. Uni-multivariate analyses showed that age at onset and presence of S1 lesions at biopsy were significantly associated with lower chances of complete remission (HR 0.899; p0.041, and HR 0.160; p0.013, respectively). No specific treatment predicted outcome.

Conclusions:

Our study has documented that pediatric IgAN has a significant probability of complete remission at 10 years from onset, and a limited probability of recurrence within 6 years from remission. The greatest chances of complete remission were observed in younger children and in the absence of glomerulosclerosis on biopsy.