IgM Deposition And Clinical Pathological Features And Prognosis Of Mesangial Proliferative Glomerulonephritis In Children

Objective:To explore the significance of mesangial IgM deposition of primary mesangial proliferative glomerulonephritis in childhood, in order to contribute to the basis for clinical treatment.Methods:1662 cases of hospitalized children admitted to Children’s Hospital Affiliated to Chongqing Medical University from January 1,2003 to December 31,2013 with renal needle biopsy were retrospectively analyzed, the clinical manifestation, laboratory indicators, therapeutics and outcome of primary mesangial proliferative glomerulonephritis were collected, followed by statistical analysis with SPSS17.0.Results:1.299 children met both clinical and pathologic diagnosis. The isolated IgM deposit group 51 comprised cases, non-isolated deposit group comprised 174 cases, non IgM deposit group comprised 74 cases.No statistically significant difference between the three groups in age, serum total protein,serum albumin and so on. The Proteinuria, incidence of hypertensionw and Serum IgM in The isolated IgM deposit group and non-isolated deposit group was significantly higher than that of non IgM deposition group.2. No statistically significant difference between the three groups in age, serum total protein,serum albumin and so on.The Proteinuria, incidence of hypertensionw and Serum IgM in The isolated IgM deposit group and non-isolated deposit group was significantly higher than that of non IgM deposition group.3. The IgM deposition group had a higher incidence of arteriole injury and dense deposits than non IgM deposition group. In isolated IgM deposition group, the heavy IgM deposit,the higher rate of glomerular sclerosis,and the incidence of foot process fusion.4. There was no significant difference between the three groups when comparing the response to steroid reatment.5. The Complete remission rate in isolated IgM deposit group and non-isolated deposit group was lower than that of non IgM deposition group. The recurrence rate was was significantly higher than that of non IgM deposition group (p=0.028).6. During the follow-up period,4.1% of isolated IgM deposit group progressed to renal insufficiency,14% of non-isolateds IgM deposit group progressed to renal insufficiency, non-IgM deposition group no case progressed to renal insufficiency.7.1/51 patients from IgM isolated deposit group and 3/174 patients from non-isolated deposit group underwent repeated renal biopsy.2 cases progressed to FSGS (non-isolated deposition group), The level of proteinuria in all cases were higher than before.Conclusion:1. IgM deposition and primary mesangial proliferative glomerulonephritis were related to the occurrence of proteinuria;2. The childhood primary MsPGN with mesangial IgM deposits has more severe proteinuria and pathological changes than that without mesangial IgM deposits.3. The childhood primary MsPGN with mesangial IgM deposits has obvious pathological changes and had poor response to prognosis than that of non IgM deposition group;4. More attention should be paid on patients with primary MsPGN with mesangial IgM deposits and the possible histological transition to FSGS.