Association of kidney biopsy findings with short- and medium-term outcomes in children with moderate-to-severe IgA vasculitis nephritis
| العنوان: | Association of kidney biopsy findings with short- and medium-term outcomes in children with moderate-to-severe IgA vasculitis nephritis |
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| المؤلفون: | Jérôme Harambat, Maud Sordet, Stéphane Decramer, Marc Fila, Caroline Rousset-Rouvière, Mohamed Boucekine, Michel Tsimaratos, Camille Faudeux, Julia Torrents, Vincent Guigonis, Stéphanie Clavé, Laurent Daniel |
| المساهمون: | Admin, Oskar, Assistance Publique - Hôpitaux de Marseille (APHM), CHU Bordeaux [Bordeaux], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), CHU Montpellier, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), CHU Limoges, Centre Hospitalier Universitaire de Nice (CHU Nice), Centre d'études et de recherche sur les services de santé et la qualité de vie (CEReSS), Aix Marseille Université (AMU), Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Toulouse [Toulouse] |
| المصدر: | European Journal of Pediatrics European Journal of Pediatrics, 2021, Online ahead of print. ⟨10.1007/s00431-021-04065-4⟩ European Journal of Pediatrics, Springer Verlag, 2021, Online ahead of print. ⟨10.1007/s00431-021-04065-4⟩ |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | Vasculitis, medicine.medical_specialty, Henoch-Schonlein purpura, Immunoglobulin A vasculitis nephritis, IgA Vasculitis, Biopsy, Nephrotic syndrome, Kidney biopsy, Kidney, Gastroenterology, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, Internal medicine, medicine, Humans, 030212 general & internal medicine, Child, Retrospective Studies, Nephritis, medicine.diagnostic_test, business.industry, urogenital system, International Study of Kidney Disease in Children classification, medicine.disease, Immunoglobulin A, 3. Good health, Henoch-Schönlein purpura, IgA vasculitis, Paediatric, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Pediatrics, Perinatology and Child Health, Cohort, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, Kidney disease |
| الوصف: | International audience; Assessing the initial severity of immunoglobulin A vasculitis nephritis (IgAV-N) is important due to its determining effect on kidney management and outcomes. This paper describes a multicentre paediatric cohort of IgAV-N patients and discusses relationships among clinical presentation, histological features, and kidney outcome. We retrospectively studied a cohort of 170 children with biopsy-proven IgAV-N, diagnosed between 2007 and 2017. One-quarter of the cohort (27%) presented with initial nephrotic syndrome (NS). Kidney biopsy revealed International Study of Kidney Disease (ISKDC) grade II or grade III in 83% of cases. Endocapillary proliferation was observed in 73% of patients, and chronic lesions were observed in 25%. Data analysis showed a significant association between NS at onset and endocapillary proliferation and cellular crescents. After a median follow-up of 21 months (IQR 12-39), 30% of patients had persistent proteinuria or decreased eGFR. At the end of follow-up, kidney impairment was more often observed in patients with NS at onset and those with cellular crescents and chronic lesions on initial kidney biopsy.Conclusion: This study highlights the relationship between the clinical and histological presentation of IgAV-N and the factors that affect kidney outcome. The ISKDC classification may be improved by including lesions that are more discriminating for disease severity and prognosis. What is Known: • Nephrotic syndrome (NS) or kidney failure at diagnosis and cellular crescents in more than 50% of the glomeruli are recognized as risk factors for poor kidney outcome in immunoglobulin A vasculitis nephritis (IgAV-N). • The reference histological classification of the International Study of Kidney Disease in Children (ISKDC) is primarily based on the presence and number of affected glomeruli (mesangial proliferation, cellular crescents). The updated Oxford classification, which emphasizes tubular atrophy and interstitial fibrosis, is also used to group pathological features of IgAV-N. Both classifications have limitations. What is New: • Medical treatment should not be postponed in patients with IgAV-N and NS until after biopsy, as NS at diagnosis is associated with initial histological severity and poorer kidney outcome. This proposal needs to be verified in further studies. • Endocapillary proliferation is associated with the initial severity of IgAV-N at diagnosis, while chronic glomerular changes and interstitial fibrosis are associated with poorer short- and medium-term kidney outcomes. |
| اللغة: | English |
| تدمد: | 0340-6199 1432-1076 |
| DOI: | 10.1007/s00431-021-04065-4⟩ |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::5f3d56e180304e89a0cc82402b70a217 http://hdl.handle.net/20.500.12278/94975 |
| Rights: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....5f3d56e180304e89a0cc82402b70a217 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 03406199 14321076 |
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| DOI: | 10.1007/s00431-021-04065-4⟩ |