Renal thrombotic microangiopathy is associated with poor renal survival in children with immunoglobulin A nephropathy

• Published in: Nephrology (Carlton, Vic.) Vic.), 2024-09, Vol.29 (9), p.579-587
• Main Authors: Yang, Meng, Wang, Le, Sun, Xiong‐Fei, Yin, Dong‐Qi
• Format: Article
• Language: English
• Subjects: Adolescent; Age Factors; Biopsy; Child; Child, Preschool; Children; Developmental stages; Epidemiology; Female; Glomerulonephritis, IGA - complications; Glomerulonephritis, IGA - mortality; Humans; Immunoglobulin A; immunoglobulin A nephropathy; Immunoglobulins; Kidney - pathology; Kidney - physiopathology; Male; Medical prognosis; Nephropathy; pathology; Patients; Pediatrics; Prognosis; Regression analysis; Renal failure; renal thrombotic microangiopathy; Retrospective Studies; Risk Factors; Survival; Thrombotic Microangiopathies - etiology; Thrombotic Microangiopathies - mortality; Thrombotic microangiopathy; Time Factors
• ISSN: 1320-5358; 1440-1797; 1440-1797
• DOI: 10.1111/nep.14313

Aim The aim of this study was to examine the clinical and pathological characteristics as well as the prognosis of immunoglobulin A nephropathy (IgAN) accompanied by renal thrombotic microangiopathy (rTMA) in paediatric patients. Methods After balancing epidemiological characteristics and pathological types between groups, 427 patients (rTMA group: 23, non‐rTMA group: 46) were included. The clinical and pathological features, prognosis and clinical risk factors of the two groups were analysed. Results IgAN‐rTMA children showed more severe clinical and pathological manifestations. The findings from the logistic regression analysis indicated that hypercellularity 1 (E1) (HR: 0.805, 95% CI: 0.763 ~ 1.452, P = .016), endocapillary proliferation (HR: 1.214, 95% CI: 0.093 ~ 4.815, P = .025) and C3 staining (HR: 7.554, 95% CI: 2.563 ~ 15.729, P = .037) were the risk factors for rTMA in children with IgAN. The renal survival in rTMA group was lower than non‐rTMA group (χ2 = 18.467, P = .000). Cox regression analysis showed that E1 (HR: 7.441, 95% CI: 1.095 ~ 10.768, P = .037), C3 disposition (HR: 3.414, 95% CI: 0.834 ~ 11.578, P = .027) and rTMA (HR: 8.918, 95% CI: 1.032 ~ 16.754, P = .041) were identified as independent risk factors for the development of end‐stage renal disease (ESRD). Conclusion The presence of rTMA had a significant impact on the severity and prognosis of IgAN. And rTMA has been identified as an independent risk factor for the development of renal failure in children diagnosed with IgAN. Summary at a glance Retrospective analysis of 427 immunoglobulin A nephropathy (IgAN) children in this study demonstrated renal tubular microcysts (rTMA) in children with IgAN may serve as an indicator of a more severe form of the disease, and rTMA is an risk factor for end‐stage renal disease (ESRD) in children with IgAN.