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Hypertension/prehypertension and its determinants in pediatric IgA nephropathy
Immunoglobulin A nephropathy (IgAN) is a major cause of secondary hypertension (HT) of renal origin – a significant prognostic factor of IgAN. In children, similar to HT, prehypertension (pre-HT) is becoming a significant health issue. However, the role of secondary HT and pre-HT (HT/pre-HT) in the...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7535649/ https://www.ncbi.nlm.nih.gov/pubmed/33019406 http://dx.doi.org/10.1097/MD.0000000000022310 |
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author | Fu, Qing-Ying Ma, Lu Li, Chang-Chun He, Zhi-Jun Wang, Wei-Hua Luo, Kai-Fa Liu, Yang Zhang, Zhi-Hao Yang, Zai-Bo Tang, Hai-Lian Yan, Jun-Hui |
author_facet | Fu, Qing-Ying Ma, Lu Li, Chang-Chun He, Zhi-Jun Wang, Wei-Hua Luo, Kai-Fa Liu, Yang Zhang, Zhi-Hao Yang, Zai-Bo Tang, Hai-Lian Yan, Jun-Hui |
author_sort | Fu, Qing-Ying |
collection | PubMed |
description | Immunoglobulin A nephropathy (IgAN) is a major cause of secondary hypertension (HT) of renal origin – a significant prognostic factor of IgAN. In children, similar to HT, prehypertension (pre-HT) is becoming a significant health issue. However, the role of secondary HT and pre-HT (HT/pre-HT) in the progression of pediatric IgAN remains unclear. We investigated the effects of HT/pre-HT on prognosis and its determinants as well as their correlation with clinicopathological parameters to identify more effective therapeutic targets. This single-center retrospective study compared clinicopathological features and treatment outcomes between patients with and without HT/pre-HT in 108 children with IgAN. Independent risk factors for HT/pre-HT were evaluated; segmental glomerulosclerosis was a significant variable, whose relationship with clinicopathological parameters was analyzed. Clinical outcomes of patients with and without HT/pre-HT differed considerably (P = .006) on ≥6 months follow-up. Patients with HT/pre-HT reached complete remission less frequently than those without HT/pre-HT (P = .014). Age, serum creatinine, prothrombin time, and segmental glomerulosclerosis or adhesion were independent risk factors for HT/pre-HT in pediatric IgAN (P = .012, P = .017, P = .002, and P = .016, respectively). Segmental glomerulosclerosis or adhesion was most closely associated with glomerular crescents (r = 0.456, P < .01), followed by Lees grades (r = 0.454, P < .01), renal arteriolar wall thickening (r = 0.337, P < .01), and endocapillary hypercellularity (r = 0.306, P = .001). The intensity of IgA deposits, an important marker of pathogenetic activity in IgAN, was significantly associated with the intensity and location of fibrinogen deposits (intensity: r = 0.291, P = .002; location: r = 0.275, P = .004). HT/pre-HT in pediatric IgAN patients is an important modifiable factor. A relationship is observed between HT/pre-HT and its determinants, especially segmental glomerulosclerosis. Potential therapeutic approaches for IgAN with HT/pre-HT might be directed toward the management of coagulation status, active lesions, and hemodynamics for slowing disease progression. |
format | Online Article Text |
id | pubmed-7535649 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-75356492020-10-14 Hypertension/prehypertension and its determinants in pediatric IgA nephropathy Fu, Qing-Ying Ma, Lu Li, Chang-Chun He, Zhi-Jun Wang, Wei-Hua Luo, Kai-Fa Liu, Yang Zhang, Zhi-Hao Yang, Zai-Bo Tang, Hai-Lian Yan, Jun-Hui Medicine (Baltimore) 5200 Immunoglobulin A nephropathy (IgAN) is a major cause of secondary hypertension (HT) of renal origin – a significant prognostic factor of IgAN. In children, similar to HT, prehypertension (pre-HT) is becoming a significant health issue. However, the role of secondary HT and pre-HT (HT/pre-HT) in the progression of pediatric IgAN remains unclear. We investigated the effects of HT/pre-HT on prognosis and its determinants as well as their correlation with clinicopathological parameters to identify more effective therapeutic targets. This single-center retrospective study compared clinicopathological features and treatment outcomes between patients with and without HT/pre-HT in 108 children with IgAN. Independent risk factors for HT/pre-HT were evaluated; segmental glomerulosclerosis was a significant variable, whose relationship with clinicopathological parameters was analyzed. Clinical outcomes of patients with and without HT/pre-HT differed considerably (P = .006) on ≥6 months follow-up. Patients with HT/pre-HT reached complete remission less frequently than those without HT/pre-HT (P = .014). Age, serum creatinine, prothrombin time, and segmental glomerulosclerosis or adhesion were independent risk factors for HT/pre-HT in pediatric IgAN (P = .012, P = .017, P = .002, and P = .016, respectively). Segmental glomerulosclerosis or adhesion was most closely associated with glomerular crescents (r = 0.456, P < .01), followed by Lees grades (r = 0.454, P < .01), renal arteriolar wall thickening (r = 0.337, P < .01), and endocapillary hypercellularity (r = 0.306, P = .001). The intensity of IgA deposits, an important marker of pathogenetic activity in IgAN, was significantly associated with the intensity and location of fibrinogen deposits (intensity: r = 0.291, P = .002; location: r = 0.275, P = .004). HT/pre-HT in pediatric IgAN patients is an important modifiable factor. A relationship is observed between HT/pre-HT and its determinants, especially segmental glomerulosclerosis. Potential therapeutic approaches for IgAN with HT/pre-HT might be directed toward the management of coagulation status, active lesions, and hemodynamics for slowing disease progression. Lippincott Williams & Wilkins 2020-10-02 /pmc/articles/PMC7535649/ /pubmed/33019406 http://dx.doi.org/10.1097/MD.0000000000022310 Text en Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0 |
spellingShingle | 5200 Fu, Qing-Ying Ma, Lu Li, Chang-Chun He, Zhi-Jun Wang, Wei-Hua Luo, Kai-Fa Liu, Yang Zhang, Zhi-Hao Yang, Zai-Bo Tang, Hai-Lian Yan, Jun-Hui Hypertension/prehypertension and its determinants in pediatric IgA nephropathy |
title | Hypertension/prehypertension and its determinants in pediatric IgA nephropathy |
title_full | Hypertension/prehypertension and its determinants in pediatric IgA nephropathy |
title_fullStr | Hypertension/prehypertension and its determinants in pediatric IgA nephropathy |
title_full_unstemmed | Hypertension/prehypertension and its determinants in pediatric IgA nephropathy |
title_short | Hypertension/prehypertension and its determinants in pediatric IgA nephropathy |
title_sort | hypertension/prehypertension and its determinants in pediatric iga nephropathy |
topic | 5200 |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7535649/ https://www.ncbi.nlm.nih.gov/pubmed/33019406 http://dx.doi.org/10.1097/MD.0000000000022310 |
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