ESPN 53rd Annual Meeting

ESPN 2021


 
A systematic review of urine biomarkers in children with IgA vasculitis nephritis.
CHLOE WILLIAMS 1 AILEEN TONER 1 RACHAEL D WRIGHT 2 LOUISE ONI 3

1- SCHOOL OF MEDICINE, UNIVERSITY OF LIVERPOOL, LIVERPOOL, UNITED KINGDOM
2- DEPARTMENT OF WOMEN’S AND CHILDREN’S HEALTH, INSTITUTE OF LIFE COURSE AND MEDICAL SCIENCES, UNIVERSITY OF LIVERPOOL, LIVERPOOL, UNITED KINGDOM
3- DEPARTMENT OF PAEDIATRIC NEPHROLOGY, ALDER HEY CHILDREN’S NHS FOUNDATION TRUST HOSPITAL, LIVERPOOL, UNITED KINGDOM
 
Introduction:

Nephritis is a recognised complication of IgA vasculitis (IgAV, Henoch-Schoenlein purpura, HSP) and contributes to 1-2% of all chronic kidney disease (CKD) stage 5. Improved detection of kidney inflammation may allow earlier intervention and reduce irreversible kidney damage in IgA vasculitis nephritis (IgAV-N). The primary aim of this study was to perform a comprehensive systematic review to evaluate the current literature to identify promising urine biomarkers that can detect and assess the severity of kidney disease in children with IgAV. 

Material and methods:

A systematic literature review was performed using 4 search engines and a search term strategy with predefined inclusion and exclusion criteria. Promising biomarkers were divided in terms of clinical or pre-clinical and described using statistical significance and area under the curve (AUC) values. 

Results:

21 studies were identified; 13 were eligible. A total of 2,446 paediatric patients were included: healthy controls (n=761), children with IgAV-N (n=1,236) and children with IgAV without nephritis (IgAV-noN, n=449). 51% were male, median age 7.9 years. The clinical markers, 24-hour protein quantity and urine protein:creatinine ratio were deemed acceptable for assessing severity of nephritis (AUC <0.8). Urinary albumin concentration (Malb) performed well (AUC 0.81-0.98). The most promising pre-clinical urinary biomarkers in predicting presence of nephritis were kidney injury molecule-1 (KIM-1) (AUC 0.93), monocyte chemotactic protein-1 (MCP-1) (AUC 0.83), N-acetyl-b-glucosaminidase (NAG) (0.76-0.96), and angiotensinogen (AGT) (AUC not available). Urinary KIM-1, MCP-1, and NAG appeared to correlate with disease severity.

Conclusions:

Further longitudinal studies are needed to assess whether these biomarkers enhance standard of care in the management of IgAV-N.