Kidney Week

Abstract: SA-PO438

Immunosuppressive Treatment in Children with IgA Nephropathy and Evidence to Support the Clinical Value of Podocytopathic Features

Session Information

• Pediatric Nephrology - II
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

• 1600 Pediatric Nephrology

Authors

• Alexandra, Cambier, Robert Debré hospital, Paris, France

Cambier Alexandra,

• Rabant, Marion, NECKER Hospital, PARIS, France

Marion Rabant,

• Peuchmaur, Michel, APHP Université Diderot Paris7, Paris, France

Michel Peuchmaur,

• Hertig, Alexandre, Sorbonne University, Paris, France

Alexandre Hertig,

• Deschênes, Georges, Hospital Robert Debre/Pediatric Nephrology, Paris, France

Georges Deschênes,

• Salomon, Remi, hopital Necker, PARIS, France

Remi Salomon,

• Hogan, Julien, Emory University, Atlanta, Georgia, United States

Julien Hogan,

• Robert, Thomas, Assistance Publique des Hôpitaux de Marseille, Marseille, France

Thomas Robert,

Background

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

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: a groupG1, treated with steroid therapy (later in association with cyclophosphamide) and supportive care (renin angiotensin system blockade) and a group treated by supportive care alone.

Results

The two groups were not comparable, since baseline clinical data were different. eGFR in immunosupressive group significantly improved between M0 and M6 from 89.9 (61.2–114.5) to 111.7 (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 supportive care group 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.

Conclusion

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 prognosis for children, whereas the characteristics of podocytopathy are strongly predictive of renal prognosis.