ESPN 51th Annual Meeting

ESPN 2018


 
Immunosuppressive treatment in children with IgA nephropathy and evidence to support the clinical value of podocytopathic features
CAMBIER ALEXANDRA 1 MARION RABANT 2 PEUCHMAUR MICHEL 1 ANNE COUDERC 1 ALEXANDRE HERTIG 3 GEORGES DESCHENES 1 SALOMON RéMI 2 HOGAN JULIEN 1 ROBERT THOMAS 4

1- Pediatric Department of Nephrology and Transplantation, Assistance Publique-Hôpitaux de Paris, Hôpital Robert-Debré, Paris, France
2- Service de Pathologie, Hôpital Universitaire Hôpital Necker APHP, Paris, France
3- Department of Nephrology, Transplantation and Emergency, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France
4- Centre de néphrologie et transplantation rénale, Assistance Publique-Hôpitaux de Marseille, Hôpital de la Conception, Marseille, France
 
Introduction:

There is a need for treatment guidelines and prognostic factor identification in children with primary IgA nephropathy (IgAN).We analyzedthe causative effect of steroids and the applicability of the Oxford classification.

Material and methods:

Data on 82 consecutive children (mean 10.6 years; median follow-up 3.3 years)  were reviewed.21 patients (25.6%) presented with acute kidney injury, and 6 (7.3%) with nephrotic syndrome. Renal biopsies were scored for Oxford classification, podocytopathic features, and extracapillary proliferation in two groups: G1, treated with steroid therapy(later in association with cyclophosphamide) and supportive care (renin angiotensin system blockade) and G3, on supportivecare alone.

 

Results:

The two groups were not comparable, since baseline clinical data were differenteGFR in G1 significantly improved between M0 and M6 from 89.9 (61.2–114.5) to111.7 (101.7–120)ml/min/1.73m2, p=0.001). Proteinuria also significantly decreased from (1.6 (1–4.3) to 0.3 (0.2–0.7)g/g creat, p<0.001). In the G3 group, eGFR and proteinuria remained stable. Podocytopathic features were predictive of renal function decline by univariable (-4.9±14.9ml/min/1.73m2, p=0.0079) and multivariable analysis and of poor renal prognosis to a combined event (renal function impairment more than 10% of the eGFR baseline or chronic kidney disease stage 3 at 6 months) in univariable and multivariable analysis. MEST-C score failed to prove its prognostic value. 

Conclusions:

Immunosuppressive treatment, especially steroid therapy, seems beneficial in children with glomerular inflammation and proliferation. The Oxford classification does not appear to be entirely appropriate in predicting long-term renal prognosisfor children, whereas the characteristics of podocytopathy are strongly predictive of renal prognosis.