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国际小儿肾脏病协会(IPNA)关于IgA肾病和IgA血管炎肾炎患儿诊断与管理的临床实践建议。

IPNA clinical practice recommendations for the diagnosis and management of children with IgA nephropathy and IgA vasculitis nephritis.

作者信息

Vivarelli Marina, Samuel Susan, Coppo Rosanna, Barratt Jonathan, Bonilla-Felix Melvin, Haffner Dieter, Gibson Keisha, Haas Mark, Abdel-Hafez Maher Ahmed, Adragna Marta, Brogan Paul, Kim Siah, Liu Isaac, Liu Zhi-Hong, Mantan Mukta, Shima Yuko, Shimuzu Masaki, Shen Qian, Trimarchi Hernan, Hahn Deirdre, Hodson Elisabeth, Pfister Ken, Alladin Areefa, Boyer Olivia, Nakanishi Koichi

机构信息

Laboratory of Nephrology, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4 00165, Rome, Italy.

Section of Nephrology, Department of Pediatrics, University of Calgary, Calgary, Canada.

出版信息

Pediatr Nephrol. 2025 Feb;40(2):533-569. doi: 10.1007/s00467-024-06502-6. Epub 2024 Sep 27.

Abstract

IgA nephropathy and IgA vasculitis with nephritis, albeit rare, represent two relatively frequent glomerular conditions in childhood. Compared to adults, pediatric IgA nephropathy has a more acute presentation, most frequently with synpharyngitic macrohematuria and histologically with more intense inflammation and less intense chronic damage. Management of these conditions is controversial and supported by little high-quality evidence. The paucity of evidence is due to the disease heterogeneity, its inter-ethnic variability, and the difficulty of extrapolating data from adult studies due to the peculiarities of the condition in children. IgA vasculitis with nephritis is a kidney manifestation of a systemic disorder, typical of the pediatric age, in which both the diagnosis of kidney involvement and its management are poorly defined, and an interdisciplinary approach is crucial. Both conditions can have a profound and long-lasting impact on kidney function and the global health of affected children. The International Pediatric Nephrology Association has therefore convened a diverse international group of experts from different disciplines to provide guidance on the recommended management of these conditions in children and to establish common definitions and define priorities for future high-quality, evidence-based collaborative studies for the benefit of children.

摘要

IgA肾病和IgA血管炎伴肾炎虽然罕见,但却是儿童时期相对常见的两种肾小球疾病。与成人相比,儿童IgA肾病的临床表现更为急性,最常见的是咽炎相关性肉眼血尿,组织学表现为炎症更强烈,慢性损伤更轻微。这些疾病的管理存在争议,且缺乏高质量证据支持。证据匮乏是由于疾病的异质性、种族间的变异性,以及由于儿童疾病的特殊性而难以从成人研究中推断数据。IgA血管炎伴肾炎是一种典型的儿童系统性疾病的肾脏表现,其中肾脏受累的诊断及其管理都不明确,多学科方法至关重要。这两种疾病都可能对受影响儿童的肾功能和整体健康产生深远而持久的影响。因此,国际儿科肾脏病协会召集了来自不同学科的多元化国际专家小组,为儿童这些疾病的推荐管理提供指导,并建立共同定义,确定未来高质量、循证协作研究的优先事项,以造福儿童。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/954a/11666671/7d0b106cea78/467_2024_6502_Fig1_HTML.jpg

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