1P-S6-1

IGA NEPHROPATHY IN CHILDREN

Yoshikawa N¹, Ito H²

¹Department of Pediatrics, Wakayama Medical University, Wakayama, Japan and ²National Children’s Hospital, Tokyo, Japan

Knowledge concerning childhood IgA nephropathy has expanded greatly in the last 10 years. Its importance as the major form of glomerulonephritis and major contributor to the end-stage renal disease is becoming apparent in children. Treatment has not yet been established. We review treatment of IgA nephropathy in children and talk about a controlled trial by The Japanese Pediatric IgA Nephropathy Treatment Study Group.

Seventy-eight children with newly diagnosed IgA nephropathy showing diffuse mesangial proliferation were randomly assigned to receive either the combined therapy of prednisolone, azathioprine, heparin-warfarin, and dipyridamole for two years (group 1) or the combination of heparin-warfarin and dipyridamole for two years (group 2). Urinary protein excretion was significantly reduced in group 1 patients, but remained unchanged in group 2 patients. Serum IgA concentration was also significantly reduced in group 1 patients, but was unchanged in group 2 patients. Blood pressure and creatinine clearance were normal at the end of the trial in all but one group 2 patient, who developed chronic renal insufficiency. The percentage of glomeruli showing sclerosis was unchanged in group 1 patients, but significantly increased in group 2 patients. The intensity of mesangial IgA deposits significantly decreased in group 1 patients, but remained unchanged in group 2 patients. The beneficial effects of prednisolone, azathioprine, heparin-warfarin and dipyridamole treatment were accompanied by relatively few serious side effects specifically attributable to the drugs. Renal survival rate in group 1 was 100% at the 10th year after initial biopsy.

Treatment of children with severe IgA nephropathy with prednisolone, azathioprine, heparin-warfarin, and dipyridamole for two years early in the course of disease prevents immunologic renal injury and progression of the disease. A controlled trial is currently in progress to compare the effects of prednisolone, azathioprine, heparin-warfarin, and dipyridamole with those of prednisolone alone in children with severe IgA nephropathy.