A lack of KDIGO guidelines for adolescents and young adults with IgA nephropathy
Background IgA nephropathy (IgAN) is one of the most prevalent primary glomerular diseases in children and adolescents. In 2021, The Kidney Disease: Improving Global Outcomes (KDIGO) released Clinical Practice Guidelines for the Management of Glomerular Diseases as an update to the 2012 guidelines. However, the lack of available evidence for the treatment of IgAN in children has led to an absence of treatment recommendations. Clinical Case We present the case of a 19-year-old male with IgAN who was lost to follow-up after an appointment at a children's hospital 3 years prior. He presents for care at an adult hospital after running out of his medications for many months. He is found to have an elevated blood pressure of 152/97 and an elevated creatinine at 0.8 mg/dL. Discussion There is not only a need for treatment guidelines for IgAN in pediatric patients, but also a need for guidelines for adolescent patients with IgAN as they transition from pediatric to adult care. Therefore, we review the KDIGO treatment guidelines for adults with IgAN and the treatment evidence for children with IgAN and discuss the management dilemma that exists for adolescents and young adults (AYA) with IgAN. Specifically, we propose renin-angiotensin-aldosterone blockade (RASB) treatment, irrespective of blood pressure, for AYA with proteinuria >0.5 g/day. We also propose treatment with corticosteroids for patients with proteinuria >1 g/day and/or mesangial hypercellularity. Conclusion The formation of treatment guidelines for patients transitioning from pediatric to adult nephrology care is paramount..
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:39 |
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| Enthalten in: |
Pediatric nephrology - 39(2023), 1 vom: 01. Juni, Seite 297-304 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Dixon, Angelina [VerfasserIn] |
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| Links: |
Volltext [lizenzpflichtig] |
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| Anmerkungen: |
© The Author(s), under exclusive licence to International Pediatric Nephrology Association 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. |
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| doi: |
10.1007/s00467-023-06027-4 |
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| 520 | |a Background IgA nephropathy (IgAN) is one of the most prevalent primary glomerular diseases in children and adolescents. In 2021, The Kidney Disease: Improving Global Outcomes (KDIGO) released Clinical Practice Guidelines for the Management of Glomerular Diseases as an update to the 2012 guidelines. However, the lack of available evidence for the treatment of IgAN in children has led to an absence of treatment recommendations. Clinical Case We present the case of a 19-year-old male with IgAN who was lost to follow-up after an appointment at a children's hospital 3 years prior. He presents for care at an adult hospital after running out of his medications for many months. He is found to have an elevated blood pressure of 152/97 and an elevated creatinine at 0.8 mg/dL. Discussion There is not only a need for treatment guidelines for IgAN in pediatric patients, but also a need for guidelines for adolescent patients with IgAN as they transition from pediatric to adult care. Therefore, we review the KDIGO treatment guidelines for adults with IgAN and the treatment evidence for children with IgAN and discuss the management dilemma that exists for adolescents and young adults (AYA) with IgAN. Specifically, we propose renin-angiotensin-aldosterone blockade (RASB) treatment, irrespective of blood pressure, for AYA with proteinuria >0.5 g/day. We also propose treatment with corticosteroids for patients with proteinuria >1 g/day and/or mesangial hypercellularity. Conclusion The formation of treatment guidelines for patients transitioning from pediatric to adult nephrology care is paramount. | ||
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