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Mahi SL, Bahram S, Harambat J, Allard L, Merlin E, Belot A, Ranchin B, Tenenbaum J, Magnavacca M, Haumesser L, Allain-Launay E, Pietrement C, Flodrops H, Ruin M, Dossier C, Decramer S, Ballot-Schmitt C, Boyer OG, Seugé L, Ulinski T, Zaloszyc A. Pediatric ANCA vasculitis: clinical presentation, treatment, and outcomes in a French retrospective study. Pediatr Nephrol 2023; 38:2649-2658. [PMID: 36622443 DOI: 10.1007/s00467-022-05855-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 11/20/2022] [Accepted: 12/08/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Pediatric ANCA vasculitis is a rare group of diseases with a scarcity of data in children. Annual incidence appeared to increase in the last several years, placing higher interest in the clinical and therapeutical outcomes of the disorder. Also, the growing use of rituximab questions the latest outcomes in these diseases. We therefore conducted a retrospective study to better understand the current characteristics, management, and the latest outcomes of the disorder. METHODS We conducted a 9-year retrospective study of 46 children in 14 different centers across France to describe their clinical and laboratory presentations, therapeutic regimens, and kidney outcome. RESULTS P-ANCA appeared to be a potential marker for higher relapse risk. Compared to adults, we found that ear-nose-throat presentations were frequent (45.7%) and more severe. Despite an evolution in the treatment management, kidney outcome remained poor with a substantial proportion of chronic kidney disease (54.8% at 1 year). Mortality stays low with 3 patients (6.5%) deceased at the end of our study. CONCLUSION Clinical presentation was as previously described and time to diagnosis remains long. P-ANCA is a statistically significant marker for increased relapse risk. We observed a modification in the treatment regimens over the past several years with a growing use of rituximab and a decreasing use of cyclophosphamide. Despite these changes, kidney outcome remains poor and prospective studies should be conducted to assess the most appropriate therapeutic modality for each patient. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Sarah-Louisa Mahi
- Service de Pédiatrie 1, CHU University Hospital Hautepierre, 1, Avenue Molière, 67098, Strasbourg, France
| | - Siamak Bahram
- Laboratoire d'Immunologie (HUS), ImmunoRhumatologie Moléculaire (INSERM UMR_S1109), CHU Strasbourg, Strasbourg, France
| | - Jérôme Harambat
- Service de Néphrologie Pédiatrique, Centre de Référence Maladies Rénales Rares du Sud-Ouest, CHU de Bordeux, Bordeaux, France
| | - Lise Allard
- Service de Néphrologie Pédiatrique, Centre de Référence Maladies Rénales Rares du Sud-Ouest, CHU de Bordeux, Bordeaux, France
| | - Etienne Merlin
- Service de Pédiatrie Générale Multidisciplinaire, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Alexandre Belot
- Service de Néphrologie-Rhumatologie-Dermatologie Pédiatriques, Hospices Civils de Lyon, Lyon, France
| | - Bruno Ranchin
- Service de Néphrologie-Rhumatologie-Dermatologie Pédiatriques, Hospices Civils de Lyon, Lyon, France
| | - Julie Tenenbaum
- Service de Pédiatrie, CHU Arnaud de Villeneuve, Montpellier, France
| | | | | | | | | | - Hugues Flodrops
- Service de Néphrologie Pédiatrique, CHU La Réunion, La Réunion, France
| | - Mahe Ruin
- Service de Néphrologie Pédiatrique, CHU La Réunion, La Réunion, France
| | - Claire Dossier
- Service de Néphrologie Pédiatrique, CHU Robert Debré, Paris, France
| | - Stéphane Decramer
- Service de pédiatrie - néphrologie et médecine interne, CHU Toulouse, Toulouse, France
| | | | - Olivia Gillion Boyer
- Service de Néphrologie Pédiatrique, Hôpital Necker Enfants Malades AP-HP, Paris, France
| | - Laure Seugé
- Service de Néphrologie Pédiatrique, Hôpital Necker Enfants Malades AP-HP, Paris, France
| | - Tim Ulinski
- Service de Néphrologie Pédiatrique, CHU Trousseau, Paris, France
| | - Ariane Zaloszyc
- Service de Pédiatrie 1, CHU University Hospital Hautepierre, 1, Avenue Molière, 67098, Strasbourg, France.
- Laboratoire d'Immunologie (HUS), ImmunoRhumatologie Moléculaire (INSERM UMR_S1109), CHU Strasbourg, Strasbourg, France.
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