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Association of kidney biopsy findings with short- and medium-term outcomes in children with moderate-to-severe IgA vasculitis nephritis

dc.rights.licenseopenen_US
dc.contributor.authorCLAVE, Stephanie
dc.contributor.authorSORDET, Maud
dc.contributor.authorTSIMARATOS, Michel
dc.contributor.authorDECRAMER, Stephane
dc.contributor.authorFILA, Marc
dc.contributor.authorGUIGONIS, Vincent
dc.contributor.authorFAUDEUX, Camille
dc.contributor.authorDANIEL, Laurent
dc.contributor.authorTORRENTS, Julia
dc.contributor.authorBOUCEKINE, Mohamed
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorHARAMBAT, Jerome
IDREF: 110567358
dc.contributor.authorROUSSET-ROUVIERE, Caroline
dc.date.accessioned2021-07-05T10:10:07Z
dc.date.available2021-07-05T10:10:07Z
dc.date.issued2021-05-02
dc.identifier.issn1432-1076 (Electronic) 0340-6199 (Linking)en_US
dc.identifier.urihttps://oskar-bordeaux.fr/handle/20.500.12278/94975
dc.description.abstractEnAssessing 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.
dc.language.isoENen_US
dc.subject.enImmunoglobulin A vasculitis nephritis
dc.subject.enPaediatric
dc.subject.enHenoch-Schönlein purpura
dc.subject.enNephrotic syndrome
dc.subject.enKidney biopsy
dc.subject.enInternational Study of Kidney Disease in Children classification
dc.title.enAssociation of kidney biopsy findings with short- and medium-term outcomes in children with moderate-to-severe IgA vasculitis nephritis
dc.typeArticle de revueen_US
dc.identifier.doi10.1007/s00431-021-04065-4en_US
dc.subject.halSciences du Vivant [q-bio]/Santé publique et épidémiologieen_US
dc.identifier.pubmed33934234en_US
bordeaux.journalEuropean Journal of Pediatricsen_US
bordeaux.hal.laboratoriesBordeaux Population Health Research Center (BPH) - UMR 1219en_US
bordeaux.institutionUniversité de Bordeauxen_US
bordeaux.institutionINSERMen_US
bordeaux.teamLEHA_BPH
bordeaux.peerReviewedouien_US
bordeaux.inpressnonen_US
hal.identifierhal-03278031
hal.version1
hal.date.transferred2021-07-05T10:10:10Z
hal.exporttrue
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