Authors of a retrospective study of 224 children with biopsy-proven IgA nephropathy (IgAN) identified several factors associated with poorer kidney outcomes over a median 5.4 years of follow-up. Male sex, older age at biopsy, Oxford E1 and S1 lesions, absence of gross hematuria during follow-up, and failure to achieve proteinuria remission were independent risk factors for sustained eGFR below 90 mL/min/1.73 m². Age also influenced kidney-function trajectories, with approximately 12 years emerging as a potential transition point from compensatory kidney growth toward greater eGFR decline. Although only 1.34% developed kidney failure and 2.23% experienced at least a 30% eGFR decline, 12.05% met the study’s earlier surrogate endpoint for kidney impairment.
Complete kidney remission was common but not necessarily durable. About 71% of children achieved remission, defined as at least 1 year without hematuria or proteinuria and an eGFR of at least 90 mL/min/1.73 m², yet 60% of those patients subsequently relapsed, most often with recurrent proteinuria. Complete remission itself was not significantly associated with better prognosis in this cohort, reinforcing the importance of continued monitoring even after apparent disease control. Because this was a single-center retrospective study with relatively short follow-up and few hard kidney events, the authors emphasize the need for larger multicenter studies to refine pediatric risk stratification and definitions of durable remission.
Reference: Liang W, He Y, Ma X, et al. Prognosis and predictive factors in pediatric IgA nephropathy. Pediatr Nephrol. 2026 Mar;41(3):731-745. doi: 10.1007/s00467-025-06988-8.
