The scope of treatment of pediatric IgA vasculitis nephritis and its outcome: a Pediatric Nephrology Research Consortium study
verfasst von:
Mahmoud Kallash, Beth A. Vogt, Ahmed Zeid, Ei Khin, Mohammed Najjar, Ahmad Aldughiem, Elizabeth Benoit, Brian Stotter, Michelle Rheault, Jillian K. Warejko, Ankana Daga
IgA vasculitis (IgAV) is the most common type of vasculitis in children. There is a lack of consensus for management of significant IgAV nephritis (IgAVN). This study was designed to identify the most used treatment options and describe their efficacy.
Methods
This is a multicenter retrospective study of children age 1–21 years with IgAVN who were managed for at least 6 months by a nephrologist. Subjects with at least microscopic hematuria and proteinuria and/or decreased kidney function were enrolled. Kidney outcome was assessed by eGFR and urine protein/creatinine (UPC) ratios at 2–4 weeks, 3, 6, and 12 months post-diagnosis.
Results
A total of 128 subjects with median age of 7 years (range 2–18) were included. Of these, 69 subjects had kidney biopsy with crescents detected in 53%. AKI (P = 0.039), nephrosis (P = 0.038), and crescents on biopsy (P = 0.013) were more likely in older patients. Patients with UPC > 1 mg/mg were more likely to get a kidney biopsy (P < 0.001) and to be treated with steroids ± immunosuppressive (IS) agents (P = 0.001). Sixty-six percent of patients were treated with steroids and/or IS agents for variable durations. Anti-metabolite agents were the most common IS agents used with variability in dosing and duration.
At 12 months, most subjects had a normal eGFR (79%) (median 123, range 68–207 mL/min/1.73 m2) and no proteinuria (median UPC 0.15, range 0.01–4.02 mg/mg).
Conclusions
IS agents are frequently used in managing IgAVN associated with heavy proteinuria, nephrosis, and/or AKI. Prospective studies are needed to determine indications and needed duration of IS therapy.
The scope of treatment of pediatric IgA vasculitis nephritis and its outcome: a Pediatric Nephrology Research Consortium study
verfasst von
Mahmoud Kallash Beth A. Vogt Ahmed Zeid Ei Khin Mohammed Najjar Ahmad Aldughiem Elizabeth Benoit Brian Stotter Michelle Rheault Jillian K. Warejko Ankana Daga
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