1
|
Furuie K, Kuraoka S, Ban H, Hidaka Y, Nagata H, Tamura H, Nagano K, Kawano T, Furuse A, Nakazato H, Nakamura K. Ongoing impacts of childhood-onset glomerular diseases during young adulthood. Pediatr Nephrol 2024; 39:1791-1799. [PMID: 38110662 PMCID: PMC11026251 DOI: 10.1007/s00467-023-06250-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Childhood-onset glomerular disease often requires ongoing treatment and follow-up into adulthood. However, few studies have analyzed the associated impact and distress experienced by patients with this condition during the transition from childhood to adolescence and adulthood. METHODS At three facilities, we recruited patients who developed idiopathic nephrotic syndrome or IgA nephropathy during childhood and were at least 18 years old at the time of study entry. Among them, a questionnaire-based survey was administered to patients who consented to participate, and the results were analyzed in conjunction with clinical information. RESULTS Data from a total of 38 patients were analyzed. Of these patients, 15 had idiopathic nephrotic syndrome and 23 had IgA nephropathy. The age of transition from pediatrics to the adult medicine department was correlated with the number of recurrences. Many patients also reported being significantly affected by exercise restrictions and physical decline associated with their diseases and medications. Various impacts, including distress, affected decision-making regarding higher education, with patients engaging in higher education at a significantly higher rate compared with the regional average (66.7% vs. 46.9%, p = 0.028). CONCLUSION We analyzed the impact of childhood-onset glomerular disease and distress during the transition period from pediatric to adult care. This study highlighted the significant impact of medications and exercise restrictions on patients' decisions regarding higher education. Future prospective studies will be needed to examine patients' distress in more detail and establish management approaches to enhance patient quality of life.
Collapse
Affiliation(s)
- Keishiro Furuie
- Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto City, 860-8556, Japan
| | - Shohei Kuraoka
- Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto City, 860-8556, Japan.
| | - Hideki Ban
- Department of Pediatrics, Japanese Red Cross Kumamoto Hospital, Kumamoto City, Japan
| | - Yuko Hidaka
- Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto City, 860-8556, Japan
| | - Hiroko Nagata
- Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto City, 860-8556, Japan
| | - Hiroshi Tamura
- Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto City, 860-8556, Japan
| | - Koji Nagano
- Department of Pediatrics, Kumamoto Chuo Hospital, Kumamoto City, Japan
| | - Tomoyasu Kawano
- Department of Pediatrics, Kumamoto Chuo Hospital, Kumamoto City, Japan
| | - Akio Furuse
- Department of Pediatrics, Japanese Red Cross Kumamoto Hospital, Kumamoto City, Japan
| | - Hitoshi Nakazato
- Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto City, 860-8556, Japan
| | - Kimitoshi Nakamura
- Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto City, 860-8556, Japan
| |
Collapse
|
2
|
Ying D, Lu M, Zhi Y, Shi P, Cao L, Wang Q, Zhang Y, Zhang J. External validation of the pediatric International IgA Nephropathy Prediction Tool in a central China cohort. Clin Exp Nephrol 2024; 28:59-66. [PMID: 37713045 DOI: 10.1007/s10157-023-02402-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND This study aimed to externally validate the pediatric International IgA Nephropathy (IgAN) Prediction Tool updated from the adult IgAN Prediction Tool. METHODS 439 children with biopsy-confirmed idiopathic IgAN were enrolled in this external validation study. The primary outcome was a 30% decline in eGFR or end-stage kidney disease. We evaluated the discrimination using Harrell's C-index, the receiver operating characteristic (ROC) curve, and Kaplan-Meier curves for four risk groups (< 16th [low risk], ∼16 to < 50th [intermediate risk], ∼50 to < 84th [high risk], and ≥ 84th percentiles [highest risk] of linear predictor). Calibration was assessed using calibration plots. RESULTS The median follow-up time of the 439 patients was 4.5 (2.7-6.8) years, and 27 patients reached the primary outcome. Compared with the reported cohorts, our cohort was more contemporary, with milder proteinuria at biopsy, and had lower proportions of S1 and T1 lesions. Harrell's C-index and area under the ROC curve at 5 years were < 0.7 for both the models with and without race. The Kaplan-Meier curves of the risk groups were not well separated for the two models, only separated completely between the highest-risk group and the others for the model without race. The two models generally overestimated the risk of the primary outcome, CONCLUSION: The model without race could accurately distinguish the highest-risk patients from patients with low, intermediate, and high risk for kidney progression. Discrimination and calibration for the full model with or without race were unsatisfactory in this contemporary cohort in central China.
Collapse
Affiliation(s)
- Daojing Ying
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Mengke Lu
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Yuanzhao Zhi
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Peipei Shi
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Lu Cao
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Qin Wang
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Yingying Zhang
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Jianjiang Zhang
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China.
| |
Collapse
|
3
|
Mizerska-Wasiak M, Płatos E, Małdyk J, Miklaszewska M, Drożdż D, Firszt-Adamczyk A, Stankiewicz R, Bieniaś B, Sikora P, Rybi-Szumińska A, Wasilewska A, Szczepańska M, Drożynska-Duklas M, Żurowska A, Pukajło-Marczyk A, Zwolińska D, Tkaczyk M, Pańczyk-Tomaszewska M. The Outcome of Childhood Immunoglobulin A Nephropathy with Acute Kidney Injury at the Onset of the Disease-National Study. J Clin Med 2023; 12:6454. [PMID: 37892592 PMCID: PMC10607644 DOI: 10.3390/jcm12206454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
Introduction: IgA nephropathy (IgAN) is the most common glomerulonephritis worldwide. Decreased glomerular filtration rate is a known risk factor for disease progression. Aim: We aimed to examine factors that may contribute to disease progression in children that present with impaired eGFR at the onset of IgAN. Materials and methods: Of the 175 patients with IgAN from the Polish Registry of Children with IgAN and IgAVN, 54 (31%) patients with IgAN who had an onset of renal function impairment (GFR < 90 mL/min) were eligible for the study. All of them were analyzed for initial symptoms (GFR according to Schwartz formula, creatinine, proteinuria, IgA, C3), renal biopsy result with assessment by Oxford classification, treatment used (R-renoprotection, P-prednisone+R, Aza-azathioprine+P+R, Cyc-cyclophosphamide+P+R, CsA-cyclosporine+P+R, MMF-mycophenolate mofetil+P+R), and distant follow-up. Based on the GFR score obtained at the end, patients were divided into two groups: A-GFR > 90 mL/min and B-GFR < 90 mL/min. Results: In the study group, the mean age of onset was 12.87 ± 3.57 years, GFR was 66.1 ± 17.3 mL/min, and proteinuria was 18.1 (0-967) mg/kg/d. Renal biopsy was performed 0.2 (0-7) years after the onset of the disease, and MESTC score averaged 2.57 ± 1.6. Treatment was R only in 39% of children, P+R in 20%, Aza+P+R in 28%, Cyc+P+R in 9%, CsA+P+R in 7%, and MMF+P+R in 3%. The length of the observation period was 2.16 (0.05-11) years. At the follow-up, Group A had 30 patients (56%) and Group B had 24 patients (44%). There were no significant differences in any of the other biochemical parameters (except creatinine) or proteinuria values between the groups and the frequency of the MESTC score ≥ 2 and <2 was not significantly different between Groups A and B. Patients with normal GFR at the follow-up (Group A) were significantly more likely to have received prednisone and/or immunosuppressive treatment than those in Group B (p < 0.05) Conclusions: In a population of Polish children with IgAN and decreased renal function at the onset of the disease, 56% had normal GFR in remote observation. The use of immunosuppressive/corticosteroids treatment in children with IgAN and impaired glomerular filtration rate at the beginning of the disease may contribute to the normalization of GFR in the outcome, although this requires confirmation in a larger group of pediatric patients.
Collapse
Affiliation(s)
- M. Mizerska-Wasiak
- Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - E. Płatos
- Scientific Group in Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - J. Małdyk
- Department of Pathology, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - M. Miklaszewska
- Department of Pediatric Nephrology and Hypertension, Jagiellonian University Medical College, 30-663 Krakow, Poland; (M.M.); (D.D.)
| | - D. Drożdż
- Department of Pediatric Nephrology and Hypertension, Jagiellonian University Medical College, 30-663 Krakow, Poland; (M.M.); (D.D.)
| | - A. Firszt-Adamczyk
- Department of Pediatrics and Nephrology, Ludwik Rydygier Hospital, 87-100 Toruń, Poland; (A.F.-A.); (R.S.)
| | - R. Stankiewicz
- Department of Pediatrics and Nephrology, Ludwik Rydygier Hospital, 87-100 Toruń, Poland; (A.F.-A.); (R.S.)
| | - B. Bieniaś
- Department of Pediatric Nephrology, Medical University of Lublin, 20-090 Lublin, Poland; (B.B.); (P.S.)
| | - P. Sikora
- Department of Pediatric Nephrology, Medical University of Lublin, 20-090 Lublin, Poland; (B.B.); (P.S.)
| | - A. Rybi-Szumińska
- Department of Pediatrics and Nephrology, Medical University of Bialystok, 15-269 Bialystok, Poland; (A.R.-S.); (A.W.)
| | - A. Wasilewska
- Department of Pediatrics and Nephrology, Medical University of Bialystok, 15-269 Bialystok, Poland; (A.R.-S.); (A.W.)
| | - M. Szczepańska
- Department of Pediatrics, FMS in Zabrze, Silesian Medical University, 40-055 Katowice, Poland;
| | - M. Drożynska-Duklas
- Department of Pediatrics, Nephrology and Hypertension, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (M.D.-D.); (A.Ż.)
| | - A. Żurowska
- Department of Pediatrics, Nephrology and Hypertension, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (M.D.-D.); (A.Ż.)
| | - A. Pukajło-Marczyk
- Department of Pediatric Nephrology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (A.P.-M.); (D.Z.)
| | - D. Zwolińska
- Department of Pediatric Nephrology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (A.P.-M.); (D.Z.)
| | - M. Tkaczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mothers Memorial Hospital Research Institute, 93-338 Lodz, Poland;
- Department of Pediatrics, Immunology and Nephrology, Medical University of Lodz, 92-215 Lodz, Poland
| | - M. Pańczyk-Tomaszewska
- Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland;
| |
Collapse
|