ABSTRACT
The clinical course as well as the effects of the treatment in 27 children suffering from IgA nephropathy were followed in this study. The observation period lasted from 1.5 to 15.5 years, mean 9.1. The clinical picture according to changes in urine was the criterion of classification into 4 groups, and was related to the WHO classification of pathomorphological types. Hypertension as well as acute renal failure were observed in each clinical group except the group of children with erythrocyturia and/or haematuria. Depending on the pathomorphological changes in kidneys, different groups of drugs were used, e.g. anticoagulants, corticosteroids and also alkylating agents. In 9 children no treatment was prescribed. Only 6 children showed regression of urine changes: 2 of them with steroid-sensitive nephrotic syndrome and 1 with steroid-resistant nephrotic syndrome. In 12 children, erythrocyturia and proteinuria decreased and the intervals between successive seizures of haematuria became longer. In 3 of 8 children with nephrotic syndrome, chronic renal failure as well as end-stage renal disease were observed. In 2 of them hypertension was present during the entire observation period and it was difficult to achieve control using hypotensive drugs. In the remaining 2 children, regression of nephrotic syndrome was found, but slight proteinuria and hypertension are observed.
Subject(s)
Anti-Inflammatory Agents/therapeutic use , Glomerulonephritis, IGA/drug therapy , Immunosuppressive Agents/therapeutic use , Acute Kidney Injury/etiology , Adolescent , Child , Child, Preschool , Female , Follow-Up Studies , Glomerulonephritis, IGA/complications , Glomerulonephritis, IGA/physiopathology , Hematuria/etiology , Humans , Hypertension/etiology , Infant , Kidney/physiopathology , Kidney Failure, Chronic/etiology , Male , Proteinuria , Remission, Spontaneous , Retrospective Studies , Sex Factors , SteroidsABSTRACT
Skin biopsy was performed in 17 of 27 children with IgA nephropathy (IgAN) and 45 of 62 children with Schönlein-Henoch purpura (SHP). Renal biopsy was done in all patients with IgAN and in 51 of 62 with SHP. There was no correlation between presentation of immunological deposits in skin and renal biopsy. Deposits of IgA with or without other deposits or other deposits without IgA were observed in different pathomorphological states. Correlation between IgA serum concentration and presentation of deposits in skin was not observed. Attention was drawn to the high proportion of negative results in skin biopsy.
Subject(s)
Glomerulonephritis, IGA/immunology , IgA Vasculitis/immunology , Immunoglobulins/analysis , Skin/chemistry , Adolescent , Biopsy , Child , Child, Preschool , Female , Hematuria/urine , Humans , Immunoglobulin A/blood , Immunoglobulin G/blood , Immunoglobulin M/blood , Immunohistochemistry , Infant , Intracranial Pressure , MaleABSTRACT
Nephrotic syndrome was diagnosed in 5 out of 14 children with IgA nephropathy. It was steroid responsive in two children. Clinical course of the disease was characterized by multiple recurrencies and variable response to steroid therapy. Periods of a complete sensitivity to prednisone were alternating with the periods of steroid-dependence, and resistance to steroids in on patient. Steroid sensitivity of the nephrotic syndrome in IgA nephropathy in childhood is rare. Therefore, the authors emphasize features of a positive prognostic value.
