New Tool Helps Predict How Pediatric IgA Nephropathy Will Progress After a Biopsy

Sean Barbour, MD

Credit: Centre for Advancing Health Outcomes

Researchers have developed a new tool to help predict how pediatric IgA nephropathy (IgAN) might progress one to two years after a kidney biopsy.¹ Before this, only adult patients had access to a prediction tool for IgAN. This new tool can help doctors identify children who are at risk of having their kidney function worsen or developing end-stage kidney disease (ESKD) within two years after a biopsy.

The 2021 Kidney Disease Improving Global Outcomes (KDIGO) guidelines recommend that risk for kidney disease progression be determined with a tool like this, and so Sean Barbour, MD, a clinical associate professor in the division of nephrology at the University of British Columbia, and colleagues worked to update the adult model for pediatric use. The study included a diverse group of children under 18 who had IgAN confirmed by biopsy and were followed into adulthood. Patients who had advanced kidney disease within one year or didn’t have enough follow-up data were excluded from the study. The main goal was to predict the first occurrence of ESKD, which includes severe declines in kidney function or the need for dialysis or transplant.

In total, 947 children were part of the study, with 65% being male and 37% being Chinese. At the time of the biopsy, 9% were taking medication for their kidneys, and 12% had already been on immunosuppressants. By one year after biopsy, these numbers increased significantly, to 54% and 51%, respectively. Kidney function and other factors, such as protein levels in the urine, improved within the first year.

During the follow-up period (average 3.3 years), the risk of kidney disease progression over four years was about 7.2% in the 38% of participants who were followed into adulthood.

The updated prediction tool showed better results than the previous models and worked well even after further testing. The tool helped identify children at higher risk of kidney function decline. These children generally start with lower kidney function and experience a faster decline as they grow older, particularly between the ages of 15 and 18.

Although this tool is helpful, the researchers acknowledged some limitations, such as the lack of long-term data, limited ethnic diversity, and the absence of newer treatments in the study. Nonetheless, this tool is the first of its kind to help doctors identify children who are at higher risk of kidney disease progression after a biopsy.

An original version of this article was published on sister site HCPLive.

References

1. ^{Barbour SJ, Coppo R, Er L, et al. Application of the updated International IgA Nephropathy Prediction Tool in children one- or two-years post-biopsy. Kidney International. https://doi.org/10.1016/j.kint.2024.07.012}
2. ^{Kidney Disease Improving Global Outcomes. Top 10 Takeaways for Clinicians from the KDIGO 2021 Clinical Practice Guideline for the Management of IgA Nephropathy. Accessed August 12, 2024. https://kdigo.org/wp-content/uploads/2017/02/KDIGO-GD-Guideline-Key-Takeaways-for-Clinicians-IgAN.pdf}