Clinical Medicine Insights: Pediatrics

Jacob Rube¹, Alexandra Peyser¹, Freya Tarapore¹, Bari Scheckner¹, Rachel Frank RN CNN¹, Suzanne Vento RN¹, Cathy Hoffman RN¹, Douglas Charney², Elsa Valderamma², Beatrice Goilav¹ and Howard Trachtman¹

¹Department of Pediatrics. Division of Nephrology, Schneider Children’s Hospital, New Hyde Park, New York. ²Department of Pathology, North Shore-LIJ Health System, Long Island Campus of the Albert Einstein College of Medicine.

Abstract

IgA nephropathy (IgAN) is a common glomerular disease whose etiology is unknown. Previous studies have described the clinical and laboratory features but none have specifically compared patients during different time periods. This 20 year retrospective study was performed to assess trends in the severity of IgAN from 1989–2008. We reviewed 57 patient charts that contained a confirmed biopsy diagnosis of IgAN and recorded data at the time of diagnosis and the final follow-up appointment. Clinical data included physical examination, urine, and blood tests. Patients were separated into two cohorts, Cohort 1 1989–1998 and Cohort 2 1999–2008. An increase in severity was noted in Cohort 2 based on a significantly higher Up/c and lower serum albumin level. Other prognostic indicators including GFRe, hematocrit, and glomerular injury score also demonstrated a trend towards more severe disease over the past 20 years. The patients in both Cohorts received similar treatments and had comparable renal function at the last follow-up visit. Based on our findings, we suggest that although a kidney biopsy is required to diagnose IgAN, the procedure may not be necessary in patients clinically suspected of having the disease but who have normal kidney function and minimal urine abnormalities.