IgA nephropathy in pediatric patients, clinical outcomes with three types of management
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Keywords

Glomerulonephritis, IGA; children; hematuria; proteinuria; Purpura, Schoenlein-Henoch; vasculitis.

How to Cite

1.
Forero-Delgadillo J, Torres-Canchala L, Duque N, Galvis-Blanco L, Lasso R, Aguirre J, Jimenez C, Arrunategui AM, Londoño H, Restrepo JM. IgA nephropathy in pediatric patients, clinical outcomes with three types of management: Nefropatía por inmunoglobulina A en pediatría, desenlaces clínicos con diferentes esquemas de manejo. Rev. Colomb. Nefrol. [Internet]. 2020 Nov. 5 [cited 2022 Aug. 11];8(1):e422. Available from: https://revistanefrologia.org/index.php/rcn/article/view/422

Abstract

Introduction:
IgA nephropathy (IgAN) is the most common glomerular disease in the world, in Colombia belongs to 11-22 % of primary glomerulonephritis in pediatric patients. Of these, 30 % progress to chronic kidney disease.

Materials and methods:
It is a retrospective descriptive study. We used median and IRQ for continuous variables, and proportions for categorical variables, Fisher test to compare clinical outcomes.

Results:
Between 1996 to 2013 58 patients were diagnosed. The mean age at symptoms onset was 7.5 years (SD±4.2) and at the time of renal biopsy was 10 years (SD±3.8). At diagnosis, 77.6 % of the patients showed microscopic hematuria, 27.6 % gross hematuria and 81 % proteinuria, classified as severe in 29 %. Three patients required dialysis and two needed kidney transplant. Three groups with different therapeutic regimens were evaluated: first group only prednisone 34.5 % (n= 20), second group prednisone and mycophenolate mofetil (MMF) 22.4 % (n = 13) and third group without prednisone neither MMF 43.1 % (n =25). The difference in the presence of hematuria among the groups was significant (p> 0.001), being more frequent in the group without prednisone neither MMF (68 %). There were no significant differences in proteinuria, hypertension or creatinine among the groups. The median of years between the renal biopsy and the last control was 4 years RI 1-7. At five years, the renal function survival probability (GFR >90 ml/min/1.73m2) was 89.1 %.

Conclusions:
IgAN needs early recognition and strict follow-up, since it may have ominous outcomes.

https://doi.org/10.22265/acnef.8.1.422
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References

Hogg RJ. Idiopathic immunoglobulin a nephropathy in children and adolescents. Vol. 25, Pediatric Nephrology. Springer; 2010. p. 823-9. https://doi.org/10.1007/s00467-008-1096-3

D'Amico G. The commonest glomerulonephritis in the world: IgA nephropathy. Q J Med. 1987 Sep;64(245):709-27.

Nair R, Walker PD. Is IgA nephropathy the commonest primary glomerulopathy among young adults in the USA? Kidney Int. 2006 Apr;69(8):1455-8. https://doi.org/10.1038/sj.ki.5000292

Prada Rico M, Rodríguez Cuellar CI, Fernandez Hernandez M, González Chaparro LS, Prado Agredo OL, Gastelbondo Amaya R. Characterization and etiopathogenic approach of pediatric renal biopsy patients in a colombian medical center from 2007-2017. Int J Nephrol. 2018 Jun 28;2018:1-9. https://doi.org/10.1155/2018/9603453

Orozco JC, Restrepo AG, Gómez SP, Mora AM, Zapata DTS, Ríos JFN, et al. Proteinuria persistente en pacientes pediátricos, caracterización histopatológica y su influencia en la progresión de la enfermedad renal crónica. Med UPB. 2018 Jan;37(1):9-16. https://doi.org/10.18566/medupb.v37n1.a02

Arias LF, Henao J, Giraldo RD, Carvajal N, Rodelo J, Arbeláez M. Glomerular diseases in a Hispanic population: review of a regional renal biopsy database. Sao Paulo Med J. 2009;127(3):140-4. https://doi.org/10.1590/S1516-31802009000300006

Ballardie FW. IgA nephropathy treatment 25 years on: Can we halt progression? The evidence base. Nephrology Dialysis Transplantation Narnia; May 1, 2004 p. 1041-6. https://doi.org/10.1093/ndt/gfh208

Wang T, Ye F, Meng H, Zhang L, Jin X. Comparison of clinicopathological features between children and adults with IgA nephropathy. Pediatr Nephrol. 2012 Aug 5;27(8):1293-300. https://doi.org/10.1007/s00467-012-2139-3

Galla JH. IgA nephropathy. Kidney Int. 1995 Feb;47(2):377-87. https://doi.org/10.1038/ki.1995.50

Segarra A. Avances en el conocimiento de la patogenia de la nefropatía IgA: ¿nuevas perspectivas para un futuro inmediato? Vol. 30, Nefrologia. 2010. p. 501-7.

Bulut IK, Mir S, Sozeri B, Bulut MO, Sen S, Dincel N. Outcome results in children with IgA nephropathy: A single center experience. Int J Nephrol Renovasc Dis. 2012 Jan;5:23-8. https://doi.org/10.2147/IJNRD.S24684

Wyatt RJ, Julian BA. IgA nephropathy. N Engl J Med. 2013;368(25):2402-14. https://dx.doi.org/10.1056/NEJMra1206793

Yu H-H, Chiang B-L. Diagnosis and classification of IgA nephropathy. Autoimmun Rev. 2014 May;13(4-5):556-9. https://doi.org/10.1016/j.autrev.2014.01.030

Hogg RJ, Silva FG, Wyatt RJ, Reisch JS, Argyle JC, Savino DA. Prognostic indicators in children with IgA nephropathy--report of the Southwest Pediatric Nephrology Study Group. Pediatr Nephrol. 1994 Feb;8(1):15-20. https://doi.org/10.1007/BF00868251

Coronel V, Mora-Orta S, Domínguez L, Corado J, Zibaoui PI, Bethencourt S, et al. [Clinical and pathological features in Venezuelan children with IgA nephropathy]. Invest Clin. 2007 Jun;48(2):167-74.

Kitagawa T. Lessons learned from the Japanese nephritis screening study. Pediatr Nephrol. 1988 Apr;2(2):256-63. https://doi.org/10.1007/BF00862602

Kamei K, Nakanishi K, Ito S, Ishikura K, Hataya H, Honda M, et al. Risk factors for persistent proteinuria after a 2-year combination therapy for severe childhood IgA nephropathy. Pediatr Nephrol. 2015 Jun;30(6):961-7. https://doi.org/10.1007/s00467-014-3019-9

Ronkainen J, Ala-Houhala M, Autio-Harmainen H, Jahnukainen T, Koskimies O, Merenmies J, et al. Long-term outcome 19 years after childhood IgA nephritis: A retrospective cohort study. Pediatr Nephrol. 2006 Sep 13;21(9):1266-73. https://doi.org/10.1007/s00467-006-0163-x

Mitsioni A. IgA nephropathy in children. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc - Eur Ren Assoc. 2001;16 Suppl 6:123-5. https://doi.org/10.1093/ndt/16.suppl_6.123

Fabiano RCG, Pinheiro SVB, Simões e Silva AC. Immunoglobulin A nephropathy: a pathophysiology view. Vol. 65, Inflammation Research. 2016. p. 757-70. https://doi.org/10.1007/s00011-016-0962-x

Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Vol. 140, Pediatrics. 2017. p. 1-72.

Schwartz GJ, Feld LG, Langford DJ. A simple estimate of glomerular filtration rate in full-term infants during the first year of life. J Pediatr. 1984 Jun;104(6):849-54. https://doi.org/10.1016/S0022-3476(84)80479-5

International Society of Nephrology. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2013;3(1):163.

Nakanishi K, Yoshikawa N. Immunoglobulin a nephropathies in children (includes HSP). In: Pediatric Nephrology, Seventh Edition. Berlin, Heidelberg: Springer Berlin Heidelberg; 2015. p. 983-1033. https://doi.org/10.1007/978-3-662-43596-0_28

Tanaka K, Moriyama T, Iwasaki C, Takei T, Nitta K. Effect of hematuria on the outcome of IgA nephropathy with mild proteinuria. Clin Exp Nephrol. 2015 Oct;19(5):815-21. https://doi.org/10.1007/s10157-014-1068-9

Restrepo de Rovetto C. Hematuria. In: ACONEPE (Asociación colombiana de nefrología pediátrica), editor. Enfoques en Nefrología pediátrica. 1st ed. Cali; 2009.

Coppo R. Corticosteroids in IgA Nephropathy: Lessons from Recent Studies. J Am Soc Nephrol JASN. 2017 Jan;28(1):25-33. https://doi.org/10.1681/ASN.2016060647

Davin JC, Ten Berge IJ, Weening JJ. What is the difference between IgA nephropathy and Henoch-Schönlein purpura nephritis? Kidney Int. 2001 Mar;59(3):823-34. https://doi.org/10.1046/j.1523-1755.2001.00565.x

Davin J-C. Henoch-Schonlein purpura nephritis: pathophysiology, treatment, and future strategy. Clin J Am Soc Nephrol CJASN. 2011 Mar;6(3):679-89. https://doi.org/10.2215/CJN.06710810

Selewski DT, Ambruzs JM, Appel GB, Bomback AS, Matar RB, Cai Y, et al. Clinical Characteristics and Treatment Patterns of Children and Adults With IgA Nephropathy or IgA Vasculitis: Findings From the CureGN Study. Kidney Int Reports. 2018 Nov;3(6):1373-84.

Sozeri B, Mir S, Ertan P, Kara OD, Sen S. Rapidly progressive glomerulonephritis in a child with Henoch-Schönlein Vasculitis and familial Mediterranean fever. Pediatr Rheumatol. 2009 May 7;7:8. https://doi.org/10.1186/1546-0096-7-8

Donadio J, Larson TS, Bergstralh EJ, Grande JP. A randomized trial of high-dose compared with low-dose omega-3 fatty acids in severe IgA nephropathy. J Am Soc Nephrol. 2001 Sep;12(4):791-9. https://doi.org/10.1681/ASN.V124791

Chan JCM, Trachtman H. Modulating the progression in IgA nephropathy. Nephron ClinPract. 2006;104(1):c61-68. https://dx.doi.org/10.1159/000093672

Lafayette RA, Canetta PA, Rovin BH, Appel GB, Novak J, Nath KA,et al.A Randomized,Controlled Trial of Rituximab in IgA Nephropathy with Proteinuria and Renal Dysfunction.J Am Soc Nephrol. 2017;28(4):1306-13. https://dx.doi.org/10.1681/ASN.2016060640

Trimarchi H, Barratt J, Monteiro RC, Feehally J. IgA nephropathy: “State of the art”: areport from the 15th International Symposium on IgA Nephropathy celebrating the 50thanniversary of its rst description. Kidney Int. 2019;95(4):750-6. https://dx.doi.org/10.1016/j.kint.2019.01.007

Vecchio M, Bonerba B, Palmer SC, Craig JC, Ruospo M, Samuels JA,et al.Immunosuppres-sive agents for treating IgA nephropathy. Cochrane Database Syst Rev. 2015;(8):CD003965.https://dx.doi.org/10.1002/14651858.CD003965.pub2

Lv J, Zhang H, Wong MG, Jardine MJ, Hladunewich M, Jha V,et al.Effect of oral methyl-prednisolone on clinical outcomes in patients with IgA nephropathy: The TESTING ran-domized clinical trial. JAMA. 2017;318(5):432-42. https://dx.doi.org/10.1001/jama.2017.9362

Higa A, Shima Y, Hama T, Sato M, Mukaiyama H, Togawa H,et al.Long-term outcome ofchildhood IgA nephropathy with minimal proteinuria. Pediatr Nephrol. 2015;30(12):2121-7.https://dx.doi.org/10.1007/s00467-015-3176-5

Rauen T, Eitner F, Fitzner C, Sommerer C, Zeier M, Otte B,et al. Intensive SupportiveCare plus Immunosuppression in IgA Nephropathy. N Engl J Med. 2015;373(23):2225-36.https://dx.doi.org/10.1056/NEJMoa1415463

Chen Y, Li Y, Yang S, Li Y, Liang M. Ecacy and safety of mycophenolate mofetiltreatment in IgA nephropathy: a systematic review. BMC Nephrol. 2014;15(1):193. https://dx.doi.org/10.1186/1471-2369-15-193

Cattran DC, Appel GB, Hebert LA, Hunsicker LG, Pohl MA, Hoy WE,et al.A randomizedtrial of cyclosporine in patients with steroid-resistant focal segmental glomerulosclerosis.Kidney Int. 1999;56(6):2220-6. https://dx.doi.org/10.1046/j.1523-1755.1999.00778.x

Liu X, Dewei D, Sun S, Xu G, Liu H, He L,et al.Treatment of severe IgA nephropathy:mycophenolate mofetil/prednisone compared to cyclophosphamide/prednisone. Int J ClinPharmacol Ther. 2014;52(2):95-102. https://dx.doi.org/10.5414/CP201887

Peng W, Tang Y, Jiang Z, Li Z, Mi X, Qin W. The effect of calcineurin inhibitors in thetreatment of IgA nephropathy: A systematic review and meta-analysis (PRISMA). Medicine(Baltimore). 2016;95(35):e4731. https://dx.doi.org/10.1097/MD.0000000000004731

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