Treatment of IgA Nephropathy in Children: a Land Without KDIGO Guidance

Overview

Journal Pediatr Nephrol

Specialties Nephrology
Pediatrics

Date 2020 Feb 16

PMID 32060820

Citations 18

Authors

Rosanna Coppo

Affiliations

Soon will be listed here.

Abstract

IgA nephropathy (IgAN) in children is no longer considered a rare and benign disease but a nephritis with different presentations and various outcomes. The decision to initiate a treatment and the therapeutic choice depend on the individual risk of progression. The Kidney Disease: Improving Global Outcomes (KDIGO) clinical guidelines in 2012 considered that the risk factors for progression of IgAN were similar in both children and adults and suggested in some conditions to follow the adult schedules. In 2017 a KDIGO Controversies Conference on management and treatment of glomerular diseases decided not to include an update in children with IgAN since the level of evidence of treatments in children was too scarce. Children can follow the indications for adults as far as the disease is similar in the various ages. This review is aimed at discussing why the KDIGO guidelines are poorly suitable to treat children with IgAN, and there is a need to develop new prediction models for progression of IgAN in children to guide selection of the cases to be treated. The identification of different risk levels in children with IgAN may personalize the choice of available drugs and support the use of new targeted therapies.

Citing Articles

Is Childhood IgA Nephropathy Different From Adult IgA Nephropathy? A Narrative Review.

Alladin-Karan A, Samuel S, Wade A, Ravani P, Grisaru S, Lam N Can J Kidney Health Dis. 2025; 12:20543581251322571.

PMID: 40078272 PMC: 11898040. DOI: 10.1177/20543581251322571.

Expected and verified benefits from old and new corticosteroid treatments in IgA nephropathy: from trials in adults to new IPNA-KDIGO guidelines.

Peruzzi L, Coppo R Pediatr Nephrol. 2025; .

PMID: 40042624 DOI: 10.1007/s00467-025-06725-1.

Combined Therapy with Azathioprine, Prednisone, and Enalapril in Children with IgAN and IgAVN.

Mizerska-Wasiak M, Starczynski M, Wasiak W, Maldyk J, Platos E, Panczyk-Tomaszewska M J Clin Med. 2024; 13(23).

PMID: 39685773 PMC: 11642697. DOI: 10.3390/jcm13237316.

IPNA clinical practice recommendations for the diagnosis and management of children with IgA nephropathy and IgA vasculitis nephritis.

Vivarelli M, Samuel S, Coppo R, Barratt J, Bonilla-Felix M, Haffner D Pediatr Nephrol. 2024; 40(2):533-569.

PMID: 39331079 PMC: 11666671. DOI: 10.1007/s00467-024-06502-6.

Immunosuppressive therapy for IgA nephropathy in children.

Alladin A, Hahn D, Hodson E, Ravani P, Pfister K, Quinn R Cochrane Database Syst Rev. 2024; 6:CD015060.

PMID: 38864363 PMC: 11167693. DOI: 10.1002/14651858.CD015060.pub2.

References

Floege J, Barbour S, Cattran D, Hogan J, Nachman P, Tang S . Management and treatment of glomerular diseases (part 1): conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2019; 95(2):268-280. DOI: 10.1016/j.kint.2018.10.018. View

Chong L, Sautenet B, Tong A, Hanson C, Samuel S, Zappitelli M . Range and Heterogeneity of Outcomes in Randomized Trials of Pediatric Chronic Kidney Disease. J Pediatr. 2017; 186:110-117.e11. DOI: 10.1016/j.jpeds.2017.03.034. View

Niaudet P, Murcia I, Beaufils H, Broyer M, Habib R . Primary IgA nephropathies in children: prognosis and treatment. Adv Nephrol Necker Hosp. 1993; 22:121-40. View

Yoshikawa N, Ito H, Sakai T, Takekoshi Y, Honda M, Awazu M . A controlled trial of combined therapy for newly diagnosed severe childhood IgA nephropathy. The Japanese Pediatric IgA Nephropathy Treatment Study Group. J Am Soc Nephrol. 1999; 10(1):101-9. DOI: 10.1681/ASN.V101101. View

Kang Z, Li Z, Duan C, Wu T, Xun M, Ding Y . Mycophenolate mofetil therapy for steroid-resistant IgA nephropathy with the nephrotic syndrome in children. Pediatr Nephrol. 2015; 30(7):1121-9. PMC: 4446504. DOI: 10.1007/s00467-014-3041-y. View

Hogg R, Bay R, Jennette J, Sibley R, Kumar S, Fervenza F . Randomized controlled trial of mycophenolate mofetil in children, adolescents, and adults with IgA nephropathy. Am J Kidney Dis. 2015; 66(5):783-91. DOI: 10.1053/j.ajkd.2015.06.013. View

Coppo R . Biomarkers and targeted new therapies for IgA nephropathy. Pediatr Nephrol. 2016; 32(5):725-731. DOI: 10.1007/s00467-016-3390-9. View

Thompson A, Carroll K, Inker L, Floege J, Perkovic V, Boyer-Suavet S . Proteinuria Reduction as a Surrogate End Point in Trials of IgA Nephropathy. Clin J Am Soc Nephrol. 2019; 14(3):469-481. PMC: 6419287. DOI: 10.2215/CJN.08600718. View

Sevillano A, Gutierrez E, Yuste C, Cavero T, Merida E, Rodriguez P . Remission of Hematuria Improves Renal Survival in IgA Nephropathy. J Am Soc Nephrol. 2017; 28(10):3089-3099. PMC: 5619972. DOI: 10.1681/ASN.2017010108. View

10.

Coppo R, Fervenza F . Persistent Microscopic Hematuria as a Risk Factor for Progression of IgA Nephropathy: New Floodlight on a Nearly Forgotten Biomarker. J Am Soc Nephrol. 2017; 28(10):2831-2834. PMC: 5619979. DOI: 10.1681/ASN.2017060639. View

11.

Trimarchi H, Barratt J, Cattran D, Cook H, Coppo R, Haas M . Oxford Classification of IgA nephropathy 2016: an update from the IgA Nephropathy Classification Working Group. Kidney Int. 2017; 91(5):1014-1021. DOI: 10.1016/j.kint.2017.02.003. View

12.

Le W, Zeng C, Liu Z, Liu D, Yang Q, Lin R . Validation of the Oxford classification of IgA nephropathy for pediatric patients from China. BMC Nephrol. 2012; 13:158. PMC: 3519602. DOI: 10.1186/1471-2369-13-158. View

13.

Chen M, Ye X, Liang H, Yang Q . [Clinical and pathological analysis of IgA nephropathy with acute kidney injury]. Zhonghua Er Ke Za Zhi. 2016; 54(8):610-3. DOI: 10.3760/cma.j.issn.0578-1310.2016.08.012. View

14.

Barbour S, Coppo R, Zhang H, Liu Z, Suzuki Y, Matsuzaki K . Evaluating a New International Risk-Prediction Tool in IgA Nephropathy. JAMA Intern Med. 2019; 179(7):942-952. PMC: 6583088. DOI: 10.1001/jamainternmed.2019.0600. View