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PROGNOSPIC SIGNIFICANCE OF PROTEINURIA AND HISTOLOGIC ALTERATIONS AT DINGNOSIS OF IGA NEPHROPATHY IN CHILDREN

Laboratory and histologic findings at the time of biopsy were correlated with outcome in 17 children with IgA nephropathy. Eight children had less than 1 gm of proteinuria per 24 hrs (P) (group I) and 9 children more than 1 gm of P (group II) at the time of biopsy. Light microscopic findings (% crescents, activity score [maximum = 10], chronicity score [maximum = 12]) and pattern of IgA staining (mesangial only [M] or mesangial and glomerular basement membrane [M + GBM]) of the two groups were compared. The number of glomeruli showing crescent formation was higher in group II biopsies (28.1 ± 21.0%) (mean ± S.D.) than in group I biopsies (1.4 ± 2.0%) (P<.01). The activity score was 2.4 ± 1.4 for group I biopsies and 5.0 ± 2.1 for group II biopsies (P<0.01). The chronicity score was .75 ± 1.0 for group I biopsies vs. 3.9 ± 1.7 for group II biopsies (P <.01). None of the group I biopsies but 78% of group II biopsies demonstrated M + GBM deposition of IgA. After a mean follow up of two years (range 1 month to 6 years) all group I children have normal renal function and only one has P>1 gm; in contrast, 4 of 9 of group II children have decreased renal function (3 require dialysis) and 8 of 9 have P>1 gm. We conclude that children with P>1 gm at the time of diagnosis of IgA nephropathy have more severe histologic alterations including a high frequency of crescent formation and a greater incidence of GBM deposition of IgA. Such children are at risk to have persistent proteinuria and to develop renal insufficiency.