Clinical course and progression factors of chronic glomerulonephritis with hematuria syndrome in children

PURPOSE OFTHE RESEARCH: studying of clinical signs dynamics in the hematuric form of chronic glomerulonephritis (HFCGN) and frequency of chronic kidney disease (CKD) development depending on the duration of disease, revealing of unfavorable outcome factors. PATIENTS AND METHODS. Retro- and prospective analysis of nephrological examination results in patients was performed in the debut of glomerulonephritis (95 children), at duration of HFCGN less than 5 years (95 children), from 6 until 10 years (65 children), more than 10 years (45 patients). Intravital morphological research of renal tissue was carried out in 43 patients. RESULTS. Erythrocyturia was observed in the debut of glomerulonephritis in 100 % of children, in 5 years time of HFCGN course in 64,6 % (р <0,05), in 10 years time in 62,2 % (р <0,05) of patients. In the dynamics of disease the frequency of severe erythrocyturia has decreased (from 52,6 % up to 25,3 %, р <0,001) in the first 5 years of HFCGN and the frequency of moderate erythrocyturia (from 48,4 % up to 20,0 %, р <0,001) during the further course of HFCGN. Proteinuria was observed in of the patients without dependence on the duration of disease, frequency of proteinuria more than 1 g/day essentially increased after 10 years of HFCGN (up to 22,2 %, р <0,05). Arterial hypertension (AH) in the first 5 years of disease was observed in 6,3 %, after 10 years - in 17,8 % (р <0,05) of patients. The relative value of CKD occurrence intensity at duration of HFCGN less than 5 years was 3,6, from 6 until 10 years - 8,9, more than 10 years - 24,2 cases for 100 patients/years. Mainly CKD of the first stage developed. Unfavorable prognostic factors of HFCGN course were family history of nephropathy, proteinuria, АH loss of cortico-medullary differentiation in kidneys according to ultrasonic research data, increase of creatinine in blood serum, presence of hyalinosis and sclerosis in glomuluses, macrofocal infiltration of interstitium. CONCLUSION. The specialties of urinary syndrome at various duration of HFCGN in children are: the decrease in frequency and severity of erythrocyturia in 5 years, increase in frequency of proteinuria to more than 1 g/day and of AH in 10 years from the beginning of the disease. The establishment of HFCGN unfavorable prognosis factors will allow to distinguish a group of patients with the increased risk of CKD development and to prescribe the nephroprotective therapy in good time.

chronic glomerulonephritis, hematuria, children, unfavorable prognostic factors

1. Игнатова М.С. Детская нефрология. Руководство для врачей. Медицинское информационное агенство, М., 2011; 696

2. Лоскутова С.А., Чупрова А.В., Мовчан Е.А. Выживаемость больных первичным гломерулонефритом, дебютировавшем в детском возрасте. Педиатрия 2005; (4): 29-33

3. Ни А., Лучанинова В.Н. Результаты катамнестического наблюдения детей, перенесших гломерулонефрит. Педиатрия 2009; 87 (3):39-42

4. Возианов АФ, Майданник В.Г, Бидный В.Г, Багдасарова И.В. Основы нефрологии детского возраста. Книга плюс, Киев, 2002; 348

5. Клиническая нефрология детского возраста. Руководство для врачей. Ред. АВ Папаян, НД Савенкова. Левша.Санкт-Петербург, СПб., 2008; 600

6. Сергеева К. М. Факторы прогрессирования гломерулонефрита у детей. Нефрология 1997; (1): 33-38

7. Думан В Л, Шилов Е М, Батанина Н Ю. Факторы прогрессирования хронического гломерулонефрита с изолированным мочевым синдромом. Нефрология 2008; 12(1): 29-35

8. Nozawa R., Suzuki J., Takahashi A. Clinicopathological features and the prognosis of IgA nephropathy in Japanese children on long-term observation. Clin Nephrol 2005; (64):171-179

9. Halling S.F., Berg U.B. Predictors of outcome in IgA nephropathy. Pediatr Nephrol 2010;(25):1801

10. Hastings M. C., Wyatt R.J, Santos N.M. Renal survival in pediatric patients with IgA nephropathy. Pediatr. Nephrol 2007; (22) 2:317-318

11. Yata N., Nakanishi K., Shima Y. Improved renal survival in Japanese children with IgA nephropathy. Pediatr. nephrol 2008; (23) 6:905-912

12. Shima Y, Nakanishi K., Hama T. et al. Spontaneous remission in children with Ig A nephropathy. Pediatr. nephrol 2013; (28) 1:71-76

13. Warady B. A., Chadha V. Chronic kidney disease in children: the global perspective. Pediatr. Nephr 2007; (22) 12: 1999-2009