IgA nephropathy is a primary glomerulonephritis characterized by circulating IgA immune complexes that deposit in the glomeruli. It is the most common type of glomerulonephritis worldwide. This study aims to establish a new diagnostic method for IgA nephropathy in Mongolian children through kidney biopsy and comparison of clinical and laboratory features between children with IgA nephropathy and Henoch-Schonlein purpura nephritis. The study will be a case-control study of 40 children with IgA nephropathy and 120 children with Henoch-Schonlein purpura nephritis from 2006-2008 at the nephrology department

1. Diagnostic approach Ig A nephropathy D.Agiimaa M.Tsendsuren Ph.D P.Chuluunhuu

2. Introduction Ig A nephropathy: First described by Berger and Hinglais in 1968 Primary glomerulonephritis Circulating IgA immune complexes-mediated Similar in terms of pathogenesis with Shonlein-Henokh

3. Frequency Ig A nephropathy: Japan 50% (James V. 2002) Asia, Australia, South Europe 30-40% North Europe 20% (NIH GUIDE. 2005) USA 2-10% (Neiberger R. 2004) Mongolia ?

4. IgA NP: 3-16 year-old (À.V.Papayan 1997) Sex-Male>Female M:F/1:2 (T.Melvin, V.Kim 1987) 79,2% (T.Linne 1991 )

5. Clinical presentation 60-80% gross hematuria & micro hematuria 12% Acute Nephritis 10% Nephrotic Syndrome 1% Cresentic or RPGN (R.Neiberger 2004)

6. Serum IgA elevation in only 8-16% of children (Neiberger R. 2004) Kidney biopsy presence of glomerular IgA deposits accompanied by a variety of histopathologic lesions Diagnosis

7. Ig AN Poor prognosis From 15 to 40 percent of patients will eventually have end-stage renal disease ( James V. Donadio et al. 2002 ) as many as 30-50% of cases progress to end-stage renal failure in 10 years (Neiberger R. 2004) Main cause of CRF in children in MCHRC glomerulonephritis 51.6% Nephrotic+Hematuric syndrome 41% Shonlein-Henoch nephritis 31% Hematuric syndrome 19% Nephrotic syndrome 9% (Ì. Tsendsuren et al. 2005)

8. Rationale MCH Center is a referral hospital which provides pediatric nephrology service for whole country. Glomerulonephritis is one of the main causes of renal morbidity and CRF among children admitted to the Nephrology Department, MCH Center. IgA nephropathy is the most primitive glomerulonephritis, and requires the renal biopsy. So far, all types of glomerulonephritis were treated by syndromes in Mongolia. There is an urgent needs to differentiate by biopsy glomerulonephritis and IgA nephropathy since they require different treatments.

9. Aim of the study To establish a new diagnostic method of IgA N among children in Mongolia To identify and compare clinical and laboratory features (serum IgA) among children with IgAN and Shonlein-Henoch nephritis To perform kidney biopsy among children with IgAN and Shonlein-Henoch nephritis

10. Materials and Methods Study: Case-control study In the department of nephrology of the MCH Center During 2006-2008 Age 3-18 years 40 children with IgA N and 120 children with Shonlein-Henoch nephritis (case:control/1:3) Statistical analysis SPSS 11.5 for windows program

11. Outcome A new diagnostic approach for Ig A nepropathy