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Kidney Week

Abstract: SA-PO664

Predictors of Lack of Remission in Pediatric Patients with IgA Vasculitis with Nephritis: A Retrospective Review

Session Information

  • Pediatric Nephrology - 2
    October 26, 2024 | Location: Exhibit Hall, Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1900 Pediatric Nephrology

Authors

  • Hoch, Virginia, Christiana Care Health Services Inc, Wilmington, Delaware, United States
  • Yang, Sandra G., Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, United States
  • Araya, Carlos E., Nemours Children's Clinic, Orlando, Florida, United States
  • Onder, Ali Mirza, Nemours Children's Hospital Delaware, Wilmington, Delaware, United States
Background

Despite favorable outcomes in the majority of cases, 3-5% of children with IgA vasculitis with nephritis (IgAVN) fail to respond to treatment and progress to advanced chronic kidney disease or end stage renal disease (ESRD). It is therefore crucial to predict early markers of progressive disease so that treatment regimens can be quickly escalated. This retrospective study was conducted to investigate predictors of lack of remission in pediatric IgAVN patients.

Methods

We identified pediatric patients from two hospital campuses at our academic institute diagnosed with biopsy-proven IgAVN from 2013 to 2023. We retrospectively collected demographic, clinical, laboratory and histopathologic variables at diagnosis and during 2 years of follow-up. The primary outcome was lack of remission at 6 months follow-up. Secondary outcomes were progression to ESRD and lack of remission at last data point. To assess for association with lack of remission, we performed logistic regressions as well as Mann-Whitney U tests and Pearson’s chi-squared or Fisher’s exact tests for numerical and categorical variables, respectively.

Results

Thirty-one patients were identified for analysis in our study (23 male and 8 female) with mean age of 10 years at diagnosis. Remission was achieved in 26/31 (84%) of cases, with 15/31 (48%) achieving remission by 6 months. Lack of remission at 6 months was associated with presence of gross hematuria (p=0.024) and nephritic-nephrotic syndrome (p=0.022) during the study period. Three patients (9.6%) progressed to ESRD during the study period; no variables were significantly associated with this outcome. Full remission was associated with lower serum albumin (p=0.03) and higher eGFR (p=0.023) at 9 months.

Conclusion

In the studied cohort, presence of gross hematuria and nephritic-nephrotic syndrome was associated with lack of remission at 6 months. We found no early predictors for progression to ESRD. Our ESRD prevalence is higher than that in previous reports, which may be due to our sample size. We also found a lower rate of full remission and a slower rate of achieving full remission in our cohort. Further research including larger patient populations is needed to better identify predictors of lack of remission and progression to ESRD for pediatric IgAVN patients.