Immunosupressive treatment in children with IgA nephropathy and evidence to support the clinical value of podocytopathic features

Abstract Introduction 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. Method 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 and podocytopathic features in two groups: a group treated with steroid therapy (some 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/1.73m 2 , p=0.001). Proteinuria also significantly decreased from (1.6 (1–4.3) to 0.3 (0.2–0.7)g/g creat, p 2 , 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. Discussion 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.