Proteinuria remission and long-term kidney outcome in children with IgA nephropathy

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ID: 320579
2026
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Abstract
Abstract Background KDIGO and IPNA guidelines indicate a target of proteinuria < 0.2 g/day/1.73m2 in children with Immunoglobulin A nephropathy (IgAN). However, the value of proteinuria remission to this threshold was limited to small monoethnic cohorts, with unknown long-term kidney outcomes. Methods In a previously described multiethnic cohort of 1 298 children with IgAN, we selected those with proteinuria at kidney biopsy ≥ 0.2 g/day/1.73m² and analyzed the occurrence of complete and sustained proteinuria remission lasting > 90 days (CSR). Aim of the study was to investigate clinical and histological factors associated with CSR and the value on long-term eGFR decline. Results The study enrolled 709 children with different ethnicities (White, Chinese and Japanese). The median age at biopsy was 12.9 years, eGFR 95.7 ml/min/1.73m2 and proteinuria 1.2 g/day/1.73m2. MEST-C scoring detected M1 in 57% of the cases, E1 in 41.3%, S1 in 53.3%, T1-2 in 13.6% and C1-2 in 46.7%. CSR occurred in 395 children (55.7%) after time-averaged observation of 0.7 years (0.4–1.3 years) and was maintained throughout follow-up in 47.3% of the cases. In a sensitivity analysis, children who achieved CSR had significant protection from eGFR decline at 4 and 5-years (p = 0.026 and p = 0.004 respectively). During follow-up, 74.4% were treated with renin-angiotensin system blockers (RASB) and 67.4% with immunosuppressors (IS). In a Cox proportional multivariate model including time-dependent RASB and IS treatment, a significant association with CSR was detected for younger age (p = 0.009), higher eGFR (p = 0.002), absence of segmental sclerosis (p < 0.001) and RASB treatment (p < 0.001). The model including ethnicity showed a strong effect of Japanese and Chinese ethnicity (both p < 0.001) and a significant association of CSR with age, absence of S1 (p < 0.001) and T1-2 (p = 0.016) and RASB and IS treatment (both p < 0.01). Conclusions The observational study showed that the achievement of CSR in children with IgAN was associated with better eGFR outcome.
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Authors Rosanna Coppo, Giuseppe Lucisano, Licia Peruzzi, Jie Ding, Xuhui Zhong, Yuko Shima, Koichi Nakanishi, Alexandra Cambier, Robert Wyatt, Zhihong Liu, Ritsuko Katafuchi, Shoji Kagami, Yukio Yuzawa, Jialu Liu, Francesco Emma, M Coleen Hastings, María Luisa Russo, Daniela Isabel Abbrescia, Lee Er, Sean J Barbour, Daniel C Cattran, Mark Haas, Antonio Nicolucci, Francesco Paolo Schena, Valiga investigators For the International IgA Nephropathy Network, M L Russo, S Troyanov, H T Cook, I Roberts, V Tesar, D Maixnerova, S Lundberg, L Gesualdo, F Emma, L Fuiano, A Geraci, L Martino, G Beltrame, C Rollino, A Amore, R Camilla, L Peruzzi, M Praga, S Feriozzi, G Segoloni, L Colla, A Pani, D Piras, A Angioi, G Cancarini, S Ravera, M Durlik, E Moggia, J Ballarin, S Di Giulio, F Pugliese, I Serriello, A Pierucci, M Rosa, Y Caliskan, M Sever, I Kilicaslan, F Locatelli, L Del Vecchio, J F M Wetzels, H Peters, U Berg, F Carvalho, A C da Costa Ferreira, M Maggio, A Wiecek, M Ots-Rosenberg, R Magistroni, R Topaloglu, Y Bilginer, M D'Amico, M Stangou, A Papagianni, F Giacchino, D Goumenos, P Kalliakmani, K Galesic, C Geddes, K Siamopoulos, O Balafa, M Galliani, P Stratta, M Quaglia, R Bergia, R Cravero, M Salvadori, L Cirami, B Fellstrom, H Kloster Smerud, F Ferrario, T Stellato, J Egido, C Martin, J Floege, F Eitner
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Journal nephrology dialysis transplantation
Year 2026
DOI
10.1093/ndt/gfag153
URL
https://doi.org/10.1093/ndt/gfag153
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