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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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2020
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.
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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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