The Spectrum of Biopsy-Proven Glomerular Diseases among Children in China: A National, Cross-Sectional Survey

Abstract

Background and objectives: High-quality epidemiologic data on the spectrum of biopsy-proven glomerular diseases among children are limited. This study aimed to determine the profile of and temporal change in biopsy-proven pediatric glomerular diseases in China.

Design, setting, participants, & measurements: We previously conducted a nationwide kidney biopsy survey including 71,151 patients over an 11-year period from January 2004 to December 2014. A total of 7962 children younger than 18 years old from 115 hospitals across China with biopsy-proven glomerular diseases were included in this study. The demographic and clinical variables were extracted from referral records and pathology reports. The composition of pediatric glomerular diseases and clinicopathologic correlations in different sexes, age groups, and regions were assessed. The changing patterns of common glomerulopathies over the study period were examined.

Results: Nephrotic syndrome (50%) was the most frequent indication for kidney biopsy in children. Minimal change disease was the most common primary glomerular disease (29%) followed by IgA nephropathy (17%). Henoch-Schonlein purpura nephritis (13%) and lupus nephritis (9%) were the most common secondary glomerular diseases. The proportion of minimal change disease was significant higher in boys (38%) than in girls (13%), whereas lupus nephritis was more prevalent in girls (20%) than in boys (3%). Purpura nephritis (23%) was the major pathologic pattern in younger children (0-12 years old), whereas minimal change disease (33%) was the most common glomerulopathy in adolescents (13-18 years old). The clinicopathologic correlations were slightly different between sexes and age groups. We observed increases in the proportions of minimal change disease, purpura nephritis, and membranous nephropathy over the study period that were contemporaneous with a fall in the proportion of FSGS.

Conclusions: The spectrum of glomerular diseases among children varied across sexes, age groups, and regions and changed substantially from 2004 to 2014 in China.

Keywords: Adolescent; Biopsy; Child; China; Demography; Female; Glomerulonephritis, IgA; Glomerulonephritis, Membranous; Glomerulosclerosis, Focal Segmental; Humans; Kidney Glomerulus; Male; Nephrosis, Lipoid; Purpura, Schoenlein-Henoch; Referral and Consultation; Surveys and Questionnaires; glomerular disease; glomerulonephritis; kidney; kidney biopsy; lupus nephritis; nephrotic syndrome; pediatrics.

Graphical abstract

Figure 1.

The composition of major pediatric glomerulopathies is significantly different between boys and girls among 7962 children who underwent kidney biopsy in China from 2004 to 2014. P value is calculated in a generalized logistic model to compare the risk of each glomerulopathy (the corresponding proportion among patients with biopsy) in different subgroups with adjustment for age, region, hospital level that performed the biopsy, diagnosis center, and indications of biopsy. Alport, Alport nephropathy; HBVAN, hepatitis B virus-associated nephritis; IgAN, IgA nephropathy; MCD, minimal change disease; MN, membranous nephropathy; MsPGN, mesangial proliferative GN; TBMN, thin basement membrane nephropathy. *P<0.05.

Figure 2.

The composition of major pediatric glomerulopathies is significantly different between young children and adolescents among 7962 children who underwent kidney biopsy in China from 2004 to 2014. P value is calculated in a generalized logistic model to compare the risk of each glomerulopathy (the corresponding proportion among patients with biopsy) in different subgroups with adjustment for sex, region, the level of the hospital that performed the biopsy, diagnosis center, and indications of biopsy. Alport, Alport nephropathy; HBVAN, hepatitis B virus-associated nephritis; IgAN, IgA nephropathy; MCD, minimal change disease; MN, membranous nephropathy; MsPGN, mesangial proliferative GN; TBMN, thin basement membrane nephropathy. *P<0.05.

Figure 3.

The composition of major pediatric glomerular diseases has significantly changed in China from 2004 to 2014. P value is calculated in a generalized logistic model to compare the risk of each glomerulopathy (the corresponding proportion among patients with biopsy) in different subgroups with adjustment for age, sex, region, the level of the hospital that performed the biopsy, diagnosis center, and indications of biopsy. IgAN, IgA nephropathy; MCD, minimal change disease; MN, membranous nephropathy; MsPGN, mesangial proliferative GN. *P<0.05.