Coagulation Potentials in Pediatric Patients with Immunoglobulin A Nephropathy.

BACKGROUND Immunoglobulin A nephropathy (IgAN) is the most prevalent primary chronic glomerular disease in children. Understanding the changes in coagulability caused by IgAN is important for clarifying pathophysiology and choice of treatment. The coagulation potential in patients with IgAN remains to be investigated, however. We aimed to assess comprehensive coagulation potentials in pediatric patients with IgAN and explore their relationship with pathological disease severity. METHODS Fourteen children with IgAN diagnosed by renal biopsy, who were admitted at Nara Medical University Hospital between 2015 and 2020, were analyzed. Rotational thromboelastometry (ROTEM) was used to evaluate coagulation potentials. Values of ROTEM parameters in patients with IgAN were compared with those in control children. RESULTS In patients with IgAN (aged median 9.5 year), clotting time plus clot formation time (CT+CFT) was shortened (P = 0.003) and α angle was greater (P < 0.001) than those in controls, indicating a hypercoagulable state. The rate of mesangial hypercellularity of glomeruli correlated with CT+CFT, α, and maximum clot firmness (MCF) (rs = -0.79, 0.56, and 0.37). The rate of cellular/fibrocellular crescent of glomeruli correlated with CT+CFT, α, and MCF (rs = -0.41, 0.60, and 0.50). Patients with mesangial hypercellularity ≥80% of glomeruli showed reduced CT+CFT and increased α angle (P = 0.007, and 0.03). Furthermore, patients with cellular/fibrocellular crescent ≥10% of glomeruli showed the decreased CT+CFT and increased α angle (both P = 0.02). CONCLUSIONS The degree of hypercoagulable state in pediatric patients with IgAN may be associated with the pathological severity of their disease.