Departmental Bulletin Paper 〈Originals〉Changes of Glomerular Density in Childhood IgA Nephropathy

Shimada, Yoshihiro

<Abstract>Background. IgA nephropathy is the most common types of chronic glomerulonephritis in Japan. Histologic prognostic factors include marked glomerulosclerosis and tubular interstitial abnormalities. Recent studies concluded that a low glomerular density at clinical onset influenced the prognosis of adults with IgA nephropathy. However, no similar relationship has been reported between the glomerular density and prognosis in children. Methods. In 22 children diagnosed with IgA nephropathy showing an unfavorable prognosis based on renal biopsy specimen findings, we histologically compared the glomerular density and related variables before therapeutic intervention with the same variables after clinical remission. Results. No significant differences were evident in creatinine clearance or the estimated glomerular filtration rate between the 2 time points. On the other hand, urinary protein, serum IgA, serum complement C3, and total serum cholesterol were significantly lower at the time of the second biopsy than at the first biopsy. The mean glomerular density was 6.9±2.2/mm2 in the first specimen and 7.0±2.4/mm2 in the second specimen. Although few children showed low glomerular density at either time point, a negative correlation was evident between the glomerular density in the first biopsy specimen and degree of change of glomerular density over time, as was reported in adults. Furthermore, negative correlations were found between the glomerular density in the second specimen and mean glomerular area, maximum glomerular area, and glomerular volume. Glomerular enlargement was noted in children with a low glomerular density. Conclusions. No significant differences were evident in the glomerular density or its relationship to clinical prognosis between the 2 time points. However glomerular enlargement was shown in patients with low glomerular density. Kidney disease during childhood induces glomerular enlargement prior to adulthood, which can predict likelihood of be progression of IgA nephropathy even in children.

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