ASSESSMENT OF RISK FACTORS AND RATE OF PROGRESSION OF PRIMARY GLOMERULOPATHIES

Purpose of the study: to determine the rate of progression of primary chronic glomerulopathies (GP) in children and to establish the main risk factors for the development of this process. Materials and methods. 188 children who were under observation and treatment at the Republican Center for Pediatric Nephrology and Renal Replacement Therapy of the "2nd Children's City Clinical Hospital" in Minsk, aged 3 to 17 years, with morphologically verified kidney damage, were included in the study: group №1 - children with minimal change disease (MCD), n=53; group №2 with IgM nephropathy (IgMN), n=26; group №3 with focal segmental glomerulosclerosis (FSGS), n=55; group №4 with IgA nephropathy (IgAN), n=54.The duration of the period from the onset of the disease to reaching the 3rd stage of CKD and predictors that determine the rate of progression of GP using Kaplan-Meier method was studied. Results. Anamnestic, clinical, laboratory, immunological (blood concentration of markers of T and B lymphocyte activation RANTES and BAFF), proinflammatory (caspase 1, IL1β and TNFα), vascular (VEGF) and tissue (TGF1β) growth factors), metabolic status (adiponectin, leptin, obestatin, vitamin D 25 (OH) D), instrumental, morphological changes were analyzed. Each of the variables was considered as a likely risk factor for the progression of GP. Conclusion. A mathematical model has been developed for predicting the risk of progression of secondary GP in children, including risk factors as predictors: impaired renal function at the onset of the disease, non-compliance with therapy, and a decrease in the estimated glomerular filtration rate (eGFR) at the onset of the disease less than 87 ml/min. The predictive accuracy of the model was 90,9% (95%ДИ 79,3-100%).

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ASSESSMENT OF RISK FACTORS FOR PROGRESSION OF SECONDARY GLOMERUPATHIES IN CHILDREN

Medical Journal ◽

10.51922/1818-426x.2021.2.91 ◽

2021 ◽

pp. 91-96

Author(s):

I. A. Kozyro ◽

◽

A. V. Sukalo ◽

A. P. Mirilenko ◽

Keyword(s):

Risk Factors ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Predictive Accuracy ◽

Morphological Changes ◽

Systemic Vasculitis ◽

Systemic Disease ◽

Pediatric Nephrology ◽

Kidney Damage ◽

Rate Of Progression

The problem of glomerular kidney damage remains relevant in pediatric nephrology due to the variety of reasons for its development and tendency to progression. According to the data of the Belarusian Center for Pediatric Nephrology and Renal Replacement Therapy, glomerulopathies (GP) occupy 2nd place in the structure of the causes of end-stage chronic kidney disease (CKD). The peculiarities of the course of GP dictate the need to search for informative predictors of the risk of adverse events, which will predict and prevent renal damage with a high degree of probability. Purpose of the study: to determine the rate of progression of secondary GP in children and to establish the main risk factors for its development. Materials and methods. 118 patients who were under observation and treatment at the Belarusian Center for Pediatric Nephrology and Renal Replacement Therapy of the "2nd Children's City Clinical Hospital" in Minsk, aged 3 to 17 years, were included in the study. We used the method of continuous targeted selection of patients with morphologically verified kidney damage due to the systemic disease. The analysis of the data of 4 study groups was carried out: 1) children with SLE, lupus nephritis (LN), retrospective group, n = 30; 2) children with SLE, LN, prospective group, n = 35; 3) patients with nephritis due to IgA vasculitis Schoenlein- Henoch (IgAV), n = 33; 4) patients with nephritis due to systemic vasculitis (SV), including ANCA-associated (AAV), n = 20. The duration of the period from the onset of the disease to reaching the 3rd stage of CKD and predictors that determine the rate of progression of GP using Kaplan-Meier method was studied. Results. Anamnestic, clinical, laboratory, immunological (blood concentration of markers of T and B lymphocyte activation RANTES and BAFF), proinflammatory (caspase 1, IL1e and TNFa), vascular (VEGF) and tissue (TGF1fi) growth factors), metabolic status (adiponectin, leptin, obestatin, vitamin D 25 (OH) D), instrumental, morphological changes were analyzed. Each of the variables was considered as a likely risk factor for the progression of GP. Conclusion. A mathematical model has been developed for predicting the risk of progression of secondary GP in children, including risk factors as predictors: anamnestic factors of kidney damage, non-compliance with therapy, persistent nephrotic proteinuria, increased serum creatinine over 200 umol/l. The predictive accuracy of the model was 93,6 % (95 % CI 84,8-100 %).

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Characteristics of the course of nephritis associated with Iga-vasculitis Henoch-Schoenlein in children

Nephrology (Saint-Petersburg) ◽

10.36485/1561-6274-2020-24-3-64-71 ◽

2020 ◽

Vol 24 (3) ◽

pp. 64-71

Author(s):

A. V. Sukalo ◽

I. A. Kazyra

Keyword(s):

Clinical Laboratory ◽

Morphological Changes ◽

Pediatric Nephrology ◽

Morphological Characteristics ◽

Lymphocyte Activation ◽

Renal Tissue ◽

Kidney Damage ◽

Iga Vasculitis ◽

Factors Affecting ◽

Treatment Regimens

INTRODUCTION. Among systemic vasopathies in children, IgA vasculitis Henoch Schoenlein (HS) is the most common, according to various authors, kidney damage is noted in 25-80 % and usually determines the prognosis of the disease.THE AIM of the study was to analyze clinical, laboratory, immunological, morphological characteristics, features of the course and treatment of nephritis associated with IgA vasculitis HS in children, as well as factors affecting the prognosis.PATIENTS AND METHODS. The study included 31 patients with morphologically verified nephritis due to IgA vasculitis HS (18 – boys, 13 – girls) aged 3 to 17 years, who were monitored at the Nephrology Department of the "2nd Children's City Clinical Hospital" of the National Center for Pediatric Nephrology and Renal Replacement therapy in Minsk from 2010 to 2019 yrs.The following parameters were analyzed: the clinical variant of kidney damage, laboratory tests (including the study of BAFF, RANTES lymphocyte activation molecules, pro-inflammatory IL1β, caspase1, TNFα, growth factors VEGF, TGF), 24 hours monitoring and office blood pressure measurements, ECHO cardiography with indicescalculation, ultrasound of the carotid arteries with the thickness of intima-media complex, morphological changes in the renal tissue, as well as treatment regimens.RESULTS. The contribution of deGal-IgA1, markers of T and B lymphocytes activation, pro-inflammatory and profibrotic molecules in the development of the disease is shown. Arterial hypertension was registered in 42 % of children, signs of heart remodeling according to the calculated indices in 19,3 %. Decrease level of adiponectin, vitamin D, leptin, increase concentration of obestatin, Pro-BNP, hs-CRP, and TSAT indicator classify patients with nephritis due to IgA vasculitis HS at moderate risk for the developmentof cardio-vascular disorders, which suggests the need for timely correction.CONCLUSION. In most cases, nephritis with IgA vasculitis HS has a benign course with rare relapses and progression to the end stage of chronic kidney disease (6,5 %).

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