Comparative Study

. 2024 Aug;39(8):2403-2412.

doi: 10.1007/s00467-024-06361-1. Epub 2024 Apr 5.

Are children with IgA nephropathy different from adult patients?

Baige Su¹, Yuanyuan Jiang^{2

3}, Zhihui Li⁴, Jianhua Zhou⁵, Liping Rong⁶, Shipin Feng⁷, Fazhan Zhong⁸, Shuzhen Sun⁹, Dongfeng Zhang¹⁰, Zhengkun Xia¹¹, Chunyue Feng¹², Wenyan Huang¹³, Xiaoyan Li¹⁴, Chaoying Chen¹⁵, Zhihong Hao¹⁶, Mo Wang¹⁷, Li Qin¹⁸, Minguang Chen¹⁹, Yuanyuan Li^{20

21}, Juanjuan Ding²², Ying Bao²³, Xiaorong Liu²⁴, Fang Deng²⁵, Xueqin Cheng²⁶, Li Zhang²⁷, Xuan Zhang²⁸, Huandan Yang²⁹, Xiaojie Peng³⁰, Qianliang Sun⁴, Linxia Deng⁵, Xiaoyun Jiang⁶, Min Xie⁷, Yan Gao⁸, Lichun Yu⁹, Ling Liu¹⁰, Chunlin Gao¹¹, Jianhua Mao¹², Weihua Zheng¹³, Xiqiang Dang¹⁴, Hua Xia¹⁵, Yujie Wang³¹, Xuhui Zhong³², Jie Ding³³, Jicheng Lv³⁴, Hong Zhang²

Affiliations

¹ Department of Pediatric Nephrology, Peking University First Hospital, No. 1 Xi An Men Da Jie, Beijing, 100034, People's Republic of China.
² Renal Division, Peking University First Hospital, No.8 Xi Shi Ku Da Jie, Beijing, 100034, People's Republic of China.
³ Department of Nephrology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China.
⁴ Department of Nephrology, Rheumatology and Immunology, Hunan Children's Hospital, Changsha, Hunan, China.
⁵ Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430030, Hubei Province, China.
⁶ Department of Pediatric Nephrology and Rheumatology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
⁷ Department of Pediatric Nephrology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China.
⁸ Pediatric Nephrology Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, China.
⁹ Department of Pediatric Nephrology and Rheumatism and Immunology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250021, China.
¹⁰ Nephrology and Immunology Department, Children's Hospital of Hebei Province, Shijiazhuang, Hebei Province, China.
¹¹ Department of Pediatrics, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
¹² Department of Nephrology, Children Hospital of Zhejiang University School of Medicine, Hangzhou, China.
¹³ Department of Nephrology and Rheumatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
¹⁴ Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China.
¹⁵ Department of Nephrology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China.
¹⁶ Department of Pediatric, Guangzhou First People's Hospital, the Second Affiliated Hospital of South China University of Technology, Guangzhou, China.
¹⁷ Department of Nephrology, Children's Hospital of Chongqing Medical University, Chongqing, China.
¹⁸ Department of Pediatrics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming Science and Technology University, Kunming, China.
¹⁹ Department of Pediatric Nephrology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
²⁰ Department of Pediatrics, Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, 350025, China.
²¹ Department of Nephrology, Rheumatology and Immunology, Fujian Children's Hospital, Fuzhou, 350014, China.
²² Department of Pediatric Nephrology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430016, Hubei, China.
²³ Department of Nephrology, Xi'an Children's Hospital, Xian, Shaanxi, China.
²⁴ Department of Pediatric Nephrology, Beijing Children's Hospital, Capital Medical University, Beijing, China.
²⁵ Department of Nephrology, Anhui Provincial Children's Hospital, Hefei, China.
²⁶ Department of Nephrology, Children's Hospital of Nanjing Medical University, Nanjing, China.
²⁷ Department of Pediatric Nephrology, The First Hospital of Jilin University, Changchun, China.
²⁸ Department of General Medicine, Tianjin Children's Hospital, Tianjin, China.
²⁹ Department of Nephrology, Xuzhou Children's Hospital, Xuzhou Medical University, Xuzhou, China.
³⁰ Department of Nephrology, Jiangxi Provincial Children's Hospital, Nanchang, 330006, China.
³¹ Medical Data Science Center, Medical Research Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
³² Department of Pediatric Nephrology, Peking University First Hospital, No. 1 Xi An Men Da Jie, Beijing, 100034, People's Republic of China. xuhui7876@126.com.
³³ Department of Pediatric Nephrology, Peking University First Hospital, No. 1 Xi An Men Da Jie, Beijing, 100034, People's Republic of China. djnc_5855@126.com.
³⁴ Renal Division, Peking University First Hospital, No.8 Xi Shi Ku Da Jie, Beijing, 100034, People's Republic of China. jichenglv@bjmu.edu.cn.

PMID: 38578470
PMCID: PMC11199250
DOI: 10.1007/s00467-024-06361-1

Comparative Study

Are children with IgA nephropathy different from adult patients?

Baige Su et al. Pediatr Nephrol. 2024 Aug.

. 2024 Aug;39(8):2403-2412.

doi: 10.1007/s00467-024-06361-1. Epub 2024 Apr 5.

Authors

Affiliations

¹ Department of Pediatric Nephrology, Peking University First Hospital, No. 1 Xi An Men Da Jie, Beijing, 100034, People's Republic of China.
² Renal Division, Peking University First Hospital, No.8 Xi Shi Ku Da Jie, Beijing, 100034, People's Republic of China.
³ Department of Nephrology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China.
⁴ Department of Nephrology, Rheumatology and Immunology, Hunan Children's Hospital, Changsha, Hunan, China.
⁵ Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430030, Hubei Province, China.
⁶ Department of Pediatric Nephrology and Rheumatology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
⁷ Department of Pediatric Nephrology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China.
⁸ Pediatric Nephrology Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, China.
⁹ Department of Pediatric Nephrology and Rheumatism and Immunology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250021, China.
¹⁰ Nephrology and Immunology Department, Children's Hospital of Hebei Province, Shijiazhuang, Hebei Province, China.
¹¹ Department of Pediatrics, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
¹² Department of Nephrology, Children Hospital of Zhejiang University School of Medicine, Hangzhou, China.
¹³ Department of Nephrology and Rheumatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
¹⁴ Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China.
¹⁵ Department of Nephrology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China.
¹⁶ Department of Pediatric, Guangzhou First People's Hospital, the Second Affiliated Hospital of South China University of Technology, Guangzhou, China.
¹⁷ Department of Nephrology, Children's Hospital of Chongqing Medical University, Chongqing, China.
¹⁸ Department of Pediatrics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming Science and Technology University, Kunming, China.
¹⁹ Department of Pediatric Nephrology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
²⁰ Department of Pediatrics, Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, 350025, China.
²¹ Department of Nephrology, Rheumatology and Immunology, Fujian Children's Hospital, Fuzhou, 350014, China.
²² Department of Pediatric Nephrology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430016, Hubei, China.
²³ Department of Nephrology, Xi'an Children's Hospital, Xian, Shaanxi, China.
²⁴ Department of Pediatric Nephrology, Beijing Children's Hospital, Capital Medical University, Beijing, China.
²⁵ Department of Nephrology, Anhui Provincial Children's Hospital, Hefei, China.
²⁶ Department of Nephrology, Children's Hospital of Nanjing Medical University, Nanjing, China.
²⁷ Department of Pediatric Nephrology, The First Hospital of Jilin University, Changchun, China.
²⁸ Department of General Medicine, Tianjin Children's Hospital, Tianjin, China.
²⁹ Department of Nephrology, Xuzhou Children's Hospital, Xuzhou Medical University, Xuzhou, China.
³⁰ Department of Nephrology, Jiangxi Provincial Children's Hospital, Nanchang, 330006, China.
³¹ Medical Data Science Center, Medical Research Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
³² Department of Pediatric Nephrology, Peking University First Hospital, No. 1 Xi An Men Da Jie, Beijing, 100034, People's Republic of China. xuhui7876@126.com.
³³ Department of Pediatric Nephrology, Peking University First Hospital, No. 1 Xi An Men Da Jie, Beijing, 100034, People's Republic of China. djnc_5855@126.com.
³⁴ Renal Division, Peking University First Hospital, No.8 Xi Shi Ku Da Jie, Beijing, 100034, People's Republic of China. jichenglv@bjmu.edu.cn.

PMID: 38578470
PMCID: PMC11199250
DOI: 10.1007/s00467-024-06361-1

Abstract

Background: Previously, several studies have indicated that pediatric IgA nephropathy (IgAN) might be different from adult IgAN, and treatment strategies might be also different between pediatric IgAN and adult IgAN.

Methods: We analyzed two prospective cohorts established by pediatric and adult nephrologists, respectively. A comprehensive analysis was performed investigating the difference in clinical and pathological characteristics, treatment, and prognosis between children and adults with IgAN.

Results: A total of 1015 children and 1911 adults with IgAN were eligible for analysis. More frequent gross hematuria (88% vs. 20%, p < 0.0001) and higher proteinuria (1.8 vs. 1.3 g/d, p < 0.0001) were seen in children compared to adults. In comparison, the estimated glomerular filtration rate (eGFR) was lower in adults (80.4 vs. 163 ml/min/1.73 m², p < 0.0001). Hypertension was more prevalent in adult patients. Pathologically, a higher proportion of M1 was revealed (62% vs. 39%, p < 0.0001) in children than in adults. S1 (62% vs. 28%, p < 0.0001) and T1-2 (34% vs. 8%, p < 0.0001) were more frequent in adults. Adjusted by proteinuria, eGFR, and hypertension, children were more likely to be treated with glucocorticoids than adults (87% vs. 45%, p < 0.0001). After propensity score matching, in IgAN with proteinuria > 1 g/d, children treated with steroids were 1.87 (95% CI 1.16-3.02, p = 0.01) times more likely to reach complete remission of proteinuria compared with adults treated with steroids.

Conclusions: Children present significantly differently from adults with IgAN in clinical and pathological manifestations and disease progression. Steroid response might be better in children.

Keywords: Adults; Children; IgA nephropathy; Remission of proteinuria; Steroid.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

None — A higher resolution version of the Graphical abstract is available as Supplementary information

**Fig. 1**
Comparison of the complete remission rate of proteinuria between children and adults

**Fig. 2**
Survival curve of patients with complete remission of proteinuria between the pediatric and adult groups with proteinuria > 1 g/d after propensity score matching

**Fig. 3**
Survival curve of complete remission of proteinuria between children and adults prescribed with steroids after propensity score matching

See this image and copyright information in PMC

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Are children with IgA nephropathy different from adult patients?

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Are children with IgA nephropathy different from adult patients?

Authors

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Abstract

Conflict of interest statement

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