IgA Nephropathy in Children

Yoshikawa, Nirishige; Iijima, Kazumoto; Ito, Hiroshi

doi:10.1159/000045467

Cited by 35 publications

(17 citation statements)

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“…There have been several reports on the treatment of diffuse IgAN in children with risk factors (Waldo et al 1989;Yoshikawa et al 1999a;Kawasaki et al 2004b). Waldo et al (1989) reported that alternate-day prednisone therapy was effective in childhood IgAN and that none of the children they treated developed renal insufficiency.…”

Section: Discussionmentioning

confidence: 99%

“…IgAN is the most common form of chronic glomerulonephritis worldwide, and progresses to end-stage renal failure in up to 30% of patients (Hogg et al 1994;Yoshikawa et al 1999a;Nozawa et al 2005). Although the pathogenic mechanisms of IgAN have yet to be fully characterized, it has been postulated that in it glomerular damage occurs as a result of the deposition of IgA-containing immune complexes, which has led to the use of immunosuppressive drugs such as steroids, cyclophosphamide, azathioprine, and mizoribine to treat it (Welch et al 1992;Yoshikawa et al 1999b;Kawasaki et al 2004a, b).…”

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confidence: 99%

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Tonsillectomy with Methylprednisolone Pulse Therapy as Rescue Treatment for Steroid-Resistant IgA Nephropathy in Children

Kawasaki

Suyama

Abe

et al. 2009

Tohoku J. Exp. Med.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Tonsillectomy with Methylprednisolone Pulse Therapy as Rescue Treatment for Steroid-Resistant IgA Nephropathy in Children

Kawasaki

Suyama

Abe

et al. 2009

Tohoku J. Exp. Med.

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“…c P ϭ 0.0138, at the biopsy versus at the latest follow-up in the asymptomatic group. question is that the prevalence of this disease is lower compared with the prevalence of IgA glomerulonephritis in 18% to 40% of all primary glomerular diseases (19). The prevalence of C1qN is 0.21% to 4% (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12).…”

Section: Discussionmentioning

confidence: 99%

“…However, no remarkable mesangial proliferation is found in a large number of our patients. IgA glomerulonephritis shows a wide spectrum of morphologic findings from MCD to diffuse mesangial proliferation with or without sclerotic glomeruli (19). There are some patients with IgA glomerulonephritis in whom mesangial IgA deposits disappeared through the follow-up.…”

Section: Discussionmentioning

confidence: 99%

Clinicopathologic Correlation and Outcome of C1q Nephropathy

Hisano¹,

Fukuma²,

Segawa³

et al. 2008

Clinical Journal of the American Society of Nephrology

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Background and objectives: The number of patients with C1q nephropathy (C1qN) in previous reports is small and the duration of follow-up is short. Our study describes the clinicopathologic correlation and clinical outcome through the mean follow-up period of 7.2 yr in 61 patients.Design, settings, participants, & measurements: Sixty-one patients, 1 to 67 yr of age, with C1qN were enrolled in this study. Results: According to presentation at onset, patients were divided into two groups: asymptomatic urinary abnormalities (asymptomatic) (n ‫؍‬ 36) and nephrotic syndrome (NS) (n ‫؍‬ 25). Light microscopy showed minimal change disease (MCD) in 46 patients (75%), mesangial proliferative glomerulonephritis in 7 (12%), and focal segmental glomerulosclerosis (FSGS) in 8 (13%). The prevalence of MCD was higher in the NS group than in the asymptomatic group. Nine patients in the asymptomatic group and all patients in the NS group were treated with prednisolone and/or cyclosporine. Normal urinalysis was found in 10 patients in asymptomatic group and 8 in NS group during the follow-up. Thirteen patients in the NS group were frequent relapsers at the latest follow-up. Three patients with FSGS developed chronic renal failure 8 to 15 yr after the diagnosis. C1q deposits disappeared in 3 of 8 patients receiving repeat biopsy, and 2 of these 3 showed FSGS.Conclusions: The prognosis of C1qN is good, associated with MCD in a large number. In some patients, C1q deposits disappear through the follow-up period. FSGS may develop in some patients on repeat biopsies. Further investigation is critically needed to settle this issue.

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“…The histologic sections were reviewed by two independent investigators who were unaware of the patients' clinical data at entry into the study. A diagnosis of IgAN was based on the presence of IgA as the sole or predominant Ig in the glomerular mesangium without systemic disease (9). Diffuse mesangial proliferation was defined on the basis of the World Health Organization criteria (Ͼ80% of glomeruli showing moderate or single morning dose to maintain the Thrombotest at 30 to 50% for 24 mo.…”

Section: Patientsmentioning

confidence: 99%

Steroid Treatment for Severe Childhood IgA Nephropathy

Yoshikawa¹,

Honda²,

Iijima³

et al. 2006

Clinical Journal of the American Society of Nephrology

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A previous trial showed that treatment of children with severe IgA nephropathy (IgAN) using prednisolone, azathioprine, heparin-warfarin, and dipyridamole for 2 yr early in the course of disease reduced the severity of immunologic renal injury and prevented any increase in the percentage of sclerosed glomeruli. This study compared the effects of prednisolone, azathioprine, warfarin, and dipyridamole (combination) with those of prednisolone alone in 80 children with newly diagnosed IgAN that showed diffuse mesangial proliferation. Patients were randomly assigned to receive either the combination or prednisolone alone for 2 yr. The primary end point was the disappearance of proteinuria, defined as urinary protein excretion <0.1 g/m 2 per d, and the secondary end points were urinary protein excretion at the end of treatment, the change in the percentage of sclerosed glomeruli during the trial, and adverse effects. The two study groups were similar in terms of baseline characteristics. Thirty-nine of the 40 patients who received the combination and 39 of the 40 who received prednisolone completed the trial. Thirty-six (92.3%) of the 39 patients who received the combination and 29 (74.4%) of the 39 who received prednisolone reached the primary end point by the 2-yr follow-up point (P ‫؍‬ 0.007 log-rank). The percentage of sclerosed glomeruli was unchanged in the patients who received the combination but increased from 3.1 ؎ 4.8 to 14.6 ؎ 15.2% in the prednisolone group (P ‫؍‬ 0.0003). The frequency of adverse effects was similar in the two groups. It is concluded that combination treatment may be better for severe IgAN than treatment with prednisolone alone.

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IgA Nephropathy in Children

Cited by 35 publications

References 50 publications

Tonsillectomy with Methylprednisolone Pulse Therapy as Rescue Treatment for Steroid-Resistant IgA Nephropathy in Children

Tonsillectomy with Methylprednisolone Pulse Therapy as Rescue Treatment for Steroid-Resistant IgA Nephropathy in Children

Clinicopathologic Correlation and Outcome of C1q Nephropathy

Steroid Treatment for Severe Childhood IgA Nephropathy

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