Clinical Characteristics and Renal Histology in Pediatric Patients with Hypertension and Prehypertension Secondary to IgA Nephropathy.

BACKGROUND/AIM: It has been shown that hypertension (HT) and prehypertension (Pre-HT) are associated with increased cardiovascular risk. However, the significance of secondary HT/Pre-HT in children with IgA nephropathy (IgAN) is uncertain. This study aimed to examine the clinical and histopathological features of pediatric patients with HT/Pre-HT.

METHODS

Data on children with IgAN from a single Chinese nephrology center were retrospectively reviewed. Morphological changes were evaluated using the Oxford classification, parameters including crescents, glomerular activity index, glomerular chronicity index (GCI), arterial lesions and Lee's grading. The clinical and pathological features were compared according to the occurrence of HT/Pre-HT.

RESULTS

One hundred and eight previously untreated children with IgAN were included. HT/Pre-HT was present in 19.44% of children. Children with HT/Pre-HT were older (14.67 ± 2.37 vs. 12.07 ± 2.94 years, p < 0.01) and had higher uric acid (380.62 vs. 301.68 μmol/l, p < 0.01) and lower estimated glomerular filtration rate (eGFR; 89.95 vs. 111.84 ml/min/1.73 m2, p < 0.01). These children also had a higher proportion of segmental glomerulosclerosis or adhesion, GCI, tubular atrophy/interstitial fibrosis and arteriole wall thickening (all p < 0.05). Blood pressure (BP) values were significantly correlated with eGFR, uric acid, segmental glomerulosclerosis or adhesion, tubular atrophy/interstitial fibrosis and arteriole wall thickening (all p < 0.05). In particular, serum uric acid levels had a stronger association with systolic BP (r = 0.434, p < 0.01).

CONCLUSION

Our results show that elevated serum uric acid level might be a marker of HT/Pre-HT. In renal histology, chronic lesions were more severe and prevalent in patients with HT/Pre-HT than in those without HT/Pre-HT.