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Rohner K, Marlais M, Ahn YH, Ali A, Alsharief A, Novak AB, Brambilla M, Cakici EK, Candan C, Canpolat N, Yu-Hin Chan E, Decramer S, Didsbury M, Durao F, Durkan AM, Düzova A, Forbes T, Gracchi V, Güngör T, Horinouchi T, Demir BK, Kobayashi Y, Koskela M, Kurt-Sukur ED, La Scola C, Langan D, Li X, Malgieri G, Mastrangelo A, Min J, Mizerska-Wasiak M, Moussaoui N, Noyan A, Nuutinen M, O'Gormon J, Okamoto T, Oni L, Oosterveld M, Pańczyk-Tomaszewska M, Parmaksiz G, Pasini A, Rianthavorn P, Roelofs J, Shen Y, Sinha R, Topaloglu R, Torres DD, Udagawa T, Wennerström M, Yap YC, Tullus K. Outcome of immunosuppression in children with IgA vasculitis-related nephritis. Nephrol Dial Transplant 2024:gfae009. [PMID: 38211969 DOI: 10.1093/ndt/gfae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND AND HYPOTHESIS IgA vasculitis with nephritis (IgAVN) is the most common vasculitis in children. Treatment recommendations are, due to a lack of evidence, based on expert opinion resulting in variation. The aim of this study was to describe clinical presentation, treatment and outcome of an extremely large cohort of children with biopsy proven IgAVN to identify prognostic risk factors and signals of treatment efficacy. METHODS Retrospective data were collected on 1148 children with biopsy proven IgAVN between 2005 and 2019 from 41 international paediatric nephrology centres across 25 countries and analyzed using multivariate analysis. The primary outcome was estimated glomerular filtration rate (eGFR) and persistent proteinuria at last follow up. RESULTS The median follow up was 3.7 years (IQR 2-6.2). At last follow up, 29% of patients had an eGFR < 90 ml/min/1.73m2, 36% had proteinuria and 3% had chronic kidney disease stage 4-5. Older age, lower eGFR at onset, hypertension and histological features of tubular atrophy and segmental sclerosis were predictors of poor outcome. There was no evidence to support any specific second line immunosuppressive regimen to be superior to others, even when further analysing subgroups of children with reduced kidney function, nephrotic syndrome or hypoalbuminemia at onset. Delayed start of immunosuppressive treatment was associated with a lower eGFR at last follow up. CONCLUSION In this large retrospective cohort, key features associated with disease outcome are highlighted. Importantly there was no evidence to support that any specific immunosuppressive treatments were superior to others. Further discovery science and well-conducted clinical trials are needed to define accurate treatment and improve outcomes of IgAVN.
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Affiliation(s)
- Katharina Rohner
- Department of Pediatric Nephrology, University Children's Hospital Zurich, Switzerland
| | - Matko Marlais
- Paediatric Nephrology Department, Great Ormond Street Hospital for Children, London, UK
- UCL Great Ormond Street Institute for Child Health, University College London, UK
| | - Yo Han Ahn
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Alaa Ali
- Great North Children's Hospital Newcastle, UK
| | - Abrar Alsharief
- Department of Pediatric Nephrology, The Queen Silvia Children´s Hospital, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Anja Blejc Novak
- Pediatric Nephrology Department, Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Marta Brambilla
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Milan, Italy
| | - Evrim Kargin Cakici
- Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Cengiz Candan
- Instanbul Medeniyet University, Department of Pediatric Nephrology, Istanbul, Türkiye
| | - Nur Canpolat
- Department of Pediatric Nephrology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Eugene Yu-Hin Chan
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Hong Kong
- Department of Paediatric and Adolescent Medicine, Faculty of Medicine, The University of Hong Kong
| | - Stéphane Decramer
- Paediatric Nephrology Centre, Hôpital des Enfants, CHU Purpan, Centre de Référence du Sud-Ouest des Maladies Rénales Rares SORARE, Filière ORKiD Toulouse, France
| | - Madeleine Didsbury
- Department of Nephrology, Royal Children's Hospital, Melbourne, Australia
| | - Filipa Durao
- Pediatric Nephrology and Kidney Transplantation Unit, Department of Pediatrics, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Anne M Durkan
- Department of Nephrology, The Children's Hospital at Westmead, Sydney, Australia
| | - Ali Düzova
- Division of Pediatric Nephrology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Thomas Forbes
- Department of Nephrology, Royal Children's Hospital, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Valentina Gracchi
- Department of pediatric nephrology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tulin Güngör
- Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Tomoko Horinouchi
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Belde Kasap Demir
- İzmir Katip Çelebi University, Department of Pediatrics, Division of Pediatric Nephrology and Rheumatology, Türkiye
- Health Sciences University Tepecik Training and Research Hospital, Divisions of Pediatric Nephrology and Rheumatology, Türkiye
| | - Yasuko Kobayashi
- Gunma University Graduate School of Medicine, Department of Pediatric, Gunma, Japan
| | - Mikael Koskela
- Department of Pediatric Nephrology and Transplantation, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eda Didem Kurt-Sukur
- Division of Pediatric Nephrology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Claudio La Scola
- Nephrology and Dialysis Unit, Department of Pediatrics. IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Dean Langan
- UCL Great Ormond Street Institute for Child Health, University College London, UK
| | - Xiaozhong Li
- Pediatric Nephrologic and Immunologic Department, Children's hospital of Soochow University, China
| | - Gabriele Malgieri
- Division of Nephrology, Dialysis and Transplant, AORN Santobono Pausilipon, Napoli, Italy
| | - Antonio Mastrangelo
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Milan, Italy
| | - Jeesu Min
- Department of Pediatrics, Chungnam National University Sejong Hospital, Sejong, Korea
| | | | - Nabila Moussaoui
- Paediatric Nephrology Centre, Hôpital des Enfants, CHU Purpan, Centre de Référence du Sud-Ouest des Maladies Rénales Rares SORARE, Filière ORKiD Toulouse, France
| | - Aytul Noyan
- Baskent University, Dr Turgut Noyan Training and Research Center, Department of Pediatric Nephrology, Adana, Türkiye
| | - Matti Nuutinen
- Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
- PEDEGO Research Unit, Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Medical Research Center Oulu (MRC Oulu)
| | | | - Takayuki Okamoto
- Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Louise Oni
- Department of Women's and Children's health, Alder Hey Children's NHS Foundation Trust Hospital and University of Liverpool, UK
| | - Michiel Oosterveld
- Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, Netherlands
| | | | - Gonul Parmaksiz
- Baskent University, Dr Turgut Noyan Training and Research Center, Department of Pediatric Nephrology, Adana, Türkiye
| | - Andrea Pasini
- Nephrology and Dialysis Unit, Department of Pediatrics. IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Pornpimol Rianthavorn
- Department of Pediatrics, Faculty of Medecine, Chulalongkorn University, Bangkok, Thailand
| | - Joris Roelofs
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Yunyan Shen
- Pediatric Nephrologic and Immunologic Department, Children's hospital of Soochow University, China
| | - Rajiv Sinha
- Division of Pediatric Nephrology, Institute of Child Health, Kolkata, India
| | - Rezan Topaloglu
- Division of Pediatric Nephrology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | | | - Tomohiro Udagawa
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Martin Wennerström
- Department of Pediatric Nephrology, The Queen Silvia Children´s Hospital, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Yok Chin Yap
- Department of Paediatric, Hospital Tunku Azizah, Women and Children Hospital Kuala Lumpur, Malaysia
| | - Kjell Tullus
- Paediatric Nephrology Department, Great Ormond Street Hospital for Children, London, UK
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Cakici EK, Kurt Şükür ED, Özlü SG, Yazılıtaş F, Özdel S, Gür G, Eroğlu FK, Güngör T, Çelikkaya E, Bağlan E, Bülbül M. MEFV gene mutations in children with Henoch-Schönlein purpura and their correlations-do mutations matter? Clin Rheumatol 2019; 38:1947-1952. [PMID: 30826945 DOI: 10.1007/s10067-019-04489-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 02/16/2019] [Accepted: 02/21/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To explore the frequency of MEFV gene mutations in children with Henoch-Schönlein purpura who had no prior familial Mediterranean fever diagnosis and to evaluate the association of MEFV mutations with the clinical and laboratory features of Henoch-Schönlein purpura. METHODS Data of 1120 patients diagnosed with Henoch-Schönlein purpura were reviewed retrospectively. The spectrum and degree of organ involvement and acute phase reactant levels were documented for each patient. Blood for MEFV gene mutation analysis was obtained either at the time of the Henoch-Schönlein purpura diagnosis or during follow-up visits. Pathological specimens of patients who underwent biopsy (renal/skin) were evaluated with special consideration for immunofluorescent examinations. RESULTS Two hundred and thirty-eight (21.3%) patients were found to have one of the MEFV mutations in which exon 10 mutations were the most common (16.7%). Abdominal pain, joint involvement, scrotal involvement, and relapse were more frequent, and acute-phase reactant levels were significantly high in patients with MEFV mutations. More severe characteristics were observed in the presence of homozygous exon 10 mutations. There was no significant association between exon 2 variants and clinical course of Henoch-Schönlein purpura. Patients carrying MEFV mutations did not have significantly higher levels of IgA deposits in the biopsy materials. CONCLUSION Henoch-Schönlein purpura in patients with homozygous exon 10 MEFV mutations seems to be more severe than that in patients carrying other mutations. In patients with exon 10 MEFV mutations, Henoch-Schönlein purpura might be considered as an associated presentation of familial Mediterranean fever rather than a separate clinical entity. Key points • p.M694V mutation is more common in Henoch-Schönlein purpura than in the general population. • p.E148Q variants have no impact on clinical symptoms and laboratory findings in Henoch-Schönlein purpura patients. • The majority of Henoch-Schönlein purpura patients with familial Mediterranean fever have no IgA deposits. • Henoch-Schönlein purpura in familial Mediterranean fever patients may be considered as an integral clinical feature of familial Mediterranean fever.
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Affiliation(s)
- Evrim Kargin Cakici
- Department of Pediatric Nephrology and Rheumatology, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey.
| | - Eda Didem Kurt Şükür
- Department of Pediatric Nephrology and Rheumatology, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Sare Gülfem Özlü
- Department of Pediatric Nephrology and Rheumatology, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Fatma Yazılıtaş
- Department of Pediatric Nephrology and Rheumatology, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Semanur Özdel
- Department of Pediatric Nephrology and Rheumatology, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Gökçe Gür
- Department of Pediatric Nephrology and Rheumatology, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Fehime Kara Eroğlu
- Department of Pediatric Nephrology and Rheumatology, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Tülin Güngör
- Department of Pediatric Nephrology and Rheumatology, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Evra Çelikkaya
- Department of Pediatric Nephrology and Rheumatology, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Esra Bağlan
- Department of Pediatric Nephrology and Rheumatology, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Mehmet Bülbül
- Department of Pediatric Nephrology and Rheumatology, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
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Cakici EK, Aydog O, Eroglu FK, Yazilitas F, Ozlu SG, Uner C, Renda R, Yılmaz E, Bulbul M. Value of renal pelvic diameter and urinary tract dilation classification in the prediction of urinary tract anomaly. Pediatr Int 2019; 61:271-277. [PMID: 30636381 DOI: 10.1111/ped.13788] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/03/2018] [Accepted: 12/07/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND The aim of this study was to identify the cut-offs of postnatal anteroposterior renal pelvic diameter (APRPD), according to the urinary tract dilation (UTD) classification system, to identify the predictors of final diagnosis of UTD and the need for surgery. METHODS A total of 260 infants (336 renal units) with prenatally detected UTD were prospectively evaluated on serial ultrasonography by the same radiologist. Additional voiding cystourethrography and scintigraphy was done according to the clinical algorithm. RESULTS Prenatal and postnatal APRPD in patients with transient dilation were significantly lower than in those with urinary tract anomalies (UTA). On follow up, the slope of decrease in APRPD was significantly higher in transient dilation compared with UTA. APRPD 10 mm at first-month ultrasonography, predicted UTA with a sensitivity of 83.1%, and specificity of 71.1%. On multivariate analysis the likelihood of surgical intervention and final diagnosis were predicted independently by the UTD system risk group. CONCLUSIONS Careful ultrasonography evaluation can avoid unnecessary testing in patients with transient or clinically insignificant dilation. The UTD classification system is valid for evaluation of postnatal hydronephrosis and is reliable in predicting the need for surgical intervention.
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Affiliation(s)
- Evrim Kargin Cakici
- Department of Pediatric Nephrology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Ozlem Aydog
- Department of Pediatric Nephrology, 19 Mayis University Medical School, Samsun, Turkey
| | - Fehime Kara Eroglu
- Department of Pediatric Nephrology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Fatma Yazilitas
- Department of Pediatric Nephrology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Sare Gulfem Ozlu
- Department of Pediatric Nephrology, Yıldırım Beyazıt University Medical School, Ankara, Turkey
| | - Cigdem Uner
- Department of Radiology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Rahime Renda
- Department of Pediatric Nephrology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Engin Yılmaz
- Department of Pediatric Surgery, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Mehmet Bulbul
- Department of Pediatric Nephrology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
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