ESPN 53rd Annual Meeting

ESPN 2021


 
Evaluation of risk factors for progression of primary IgA-nephropathy in children
MARIIA PROSKURA 1 EDITA PETROSYAN 1 DMITRY KOROSTIN 1 BERTA KUSHNIR 1 PATRISIA POVILAITITE 2

1- PIROGOV RUSSIAN NATIONAL RESEARCH MEDICAL UNIVERSITY
2- STATE INSTITUTION OF HEALTH, ROSTOV REGION, PATALOANATOMICAL BUREAU
 
Introduction:

The course and outcomes of primary IgA nephropathy (IgAN) in children are variable. Unlike adults, no accurate progression factors for children have been identified yet. If timely detected it may help stratify patients, improve treatment for high-risk individuals and delay end-stage renal failure.

Material and methods:

124 children with primary IgAN were enrolled in a retrospective study. 75 children were followed up more than 2 years (the median follow-up was 28 months). The median age of onset was 11.0 years (IQR is 7.0-13.5). Patients were divided into 2 groups: group #1 - idiopathic IgAN (n = 92), group #2  - Shenlein-Henoch purpura (n = 32). The age of onset and primary admission, the level of proteinuria and glomerular filtration rate (GFR) at the onset, after 12, 24 months,at the end of follow up, mean blood pressure, medications before nephrobiopsy were analyzed. Nephrobiopsy data were classified according to the Oxford Scale. 70 children, followed for at least 2 years, showed disease progression (assessed by the GFR decline curve and the presence of persistent proteinuria), underwent next generation sequencing (NGS). Single nucleotide polymorphisms (SNP) were assessed according to the IgAN panel (panelapp.genomicsengland.co.uk/panels/156/). Progression was estimated by a decrease in GFR less than 60 ml/min/1.73 m2. Outcomes were classifyed into absence or presence of remission. A search for factors influencing GFR after 24 months of observation was carried out. Comparison and analysis of data was performed using Students t-test, Mann-Whitney, χ2, Fisher, linear regression model, Cox regression model.

Results:

Unlike adults, the predictive value of the Oxford scale in children has not been proven and is not associated with a decrease in GFR <60 ml/min/1.73 m2. GFR at the end of follow-up was lower in the first group than in the second. The level of GFR at the onset, mean blood pressure and the age of primary admission turned out to be independent factors helping detect children with an expected decrease in GFR less than 90 ml/min/1.73 m2 within 2 years. Analysis of SNP, their associations did not have a statistically significant effect on the clinical, morphological data of patients, outcomes. Perhaps the NGS results may not be representative due to the limited statistical power of the sample.

Conclusions:

The influence of morphological and genetic factors on the outcome and course of primary IgA nephropathy has not been proven. The use of multiple linear regression predicts GFR on average after 24 months of observation.