New Evidence on Pediatric IgAN Progression Supports Need for Extended Follow-Up

New insights into pediatric IgA nephropathy (IgAN) shows slow disease progression over 5 years, increased rates of complete kidney remission, and a common pattern of recurrence, supporting extended follow-up and improved predictive models.1

The silent progression of IgAN in children stems from persistently active kidney injury, which can lead to irreversible sclerotic damage. A 20-year study of early-onset IgAN found about 20% of children experienced kidney function decline or reached a combined renal endpoint, including end-stage kidney disease, doubling of serum creatinine, or death.2

The retrospective cohort study evaluated poor prognosis, estimated glomerular filtration rate (eGFR), and the patterns of kidney remission and relapse in children, aiming to identify reliable prognostic markers to guide clinical management.

“IgAN is one of the major causes of chronic kidney disease (CKD) and kidney failure among pediatric glomerulopathies, with marked heterogeneity in clinical course and prognosis,” wrote Liru Qiu, MD, PhD, department of pediatrics at Tongju Hospital, and colleagues. “We systematically analyzed baseline characteristics, clinicopathological features at biopsy, and follow-up data.”

The study included 224 patients 3-18 years of age with biopsy-proven IgAN and ≥ 3 years of follow-up. Poor prognosis was defined as persistent eGFR < 90 mL/min/1.73 m2 for ≥ 3 months, kidney failure, or a ≥ 30% reduction in eGFR from baseline. Complete kidney remission was defined as the absence of hematuria and proteinuria with eGFR ≥ 90 mL/min/1.73 m2 for ≥ 1 year, and recurrence.

During a 5.41 year median follow-up, investigators observed poor prognosis in 12.05% of patients. Notable independent risk factors were found in males, older age at biopsy, Oxford classification E1 and S1 lesions, absence of gross hematuria, and no remission of proteinuria during follow-up, whereas those with elevated birth weight had reduced risk of adverse outcome (P < .05).

Investigators also noted an association between age at biopsy, gross hematuria, and proteinuria remission status had significant time-dependent effects on eGFR slope. Patients < 12 years of age at biopsy demonstrated a decreased rate of kidney function decline compared to an increased eGFR rate for those ≥12 years of age, suggesting age of diagnosis might affect progression. When compared with isolated gross hematuria and no gross hematuria, patients with recurrent gross hematuria had an increased eGFR slope. Those with complete remission of proteinuria had a slower decline in kidney function than the non-remission group, suggesting a protective effect.

Investigators observed complete kidney remission in 70.98% of patients. The cumulative incidence of complete kidney remission at 2, 5, and 10 years post-biopsy was 23.21% (95% confidence interval [CI],17.67-28.76), 64.33% (95% CI, 57.58-71.08), and 84.03% (95% CI, 76.64-91.43), respectively. Among those in remission, 39.62% (63/159) remained relapse-free, while 60.38% (96/159) relapsed, including hematuria (29.17%), proteinuria (38.54%), or both (32.29%), underscoring the particularly elastic and variable nature of disease progression in pediatric patients with IgAN.

“Future research should leverage multicenter cohorts and integrate multi-omics approaches—including genomic, metabolic, and inflammatory profiling—to enhance prognostic accuracy and guide precision therapy in pediatric IgAN,” concluded investigators.

References

1. Liang W, He Y, Ma X, et al. Prognosis and predictive factors in pediatric IgA nephropathy. Pediatric Nephrology. Published online November 13, 2025. doi:https://doi.org/10.1007/s00467-025-06988-8

2. Peruzzi L, Coppo R. IgAN Across the Age Spectrum: The Pediatric Perspective. Seminars in Nephrology. Published online March 2025:151569. doi:https://doi.org/10.1016/j.semnephrol.2025.151569