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A lack of KDIGO guidelines for adolescents and young adults with IgA nephropathy

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Abstract

Background

IgA nephropathy (IgAN) is one of the most prevalent primary glomerular diseases in children and adolescents. In 2021, The Kidney Disease: Improving Global Outcomes (KDIGO) released Clinical Practice Guidelines for the Management of Glomerular Diseases as an update to the 2012 guidelines. However, the lack of available evidence for the treatment of IgAN in children has led to an absence of treatment recommendations.

Clinical Case

We present the case of a 19-year-old male with IgAN who was lost to follow-up after an appointment at a children's hospital 3 years prior. He presents for care at an adult hospital after running out of his medications for many months. He is found to have an elevated blood pressure of 152/97 and an elevated creatinine at 0.8 mg/dL.

Discussion

There is not only a need for treatment guidelines for IgAN in pediatric patients, but also a need for guidelines for adolescent patients with IgAN as they transition from pediatric to adult care. Therefore, we review the KDIGO treatment guidelines for adults with IgAN and the treatment evidence for children with IgAN and discuss the management dilemma that exists for adolescents and young adults (AYA) with IgAN. Specifically, we propose renin-angiotensin-aldosterone blockade (RASB) treatment, irrespective of blood pressure, for AYA with proteinuria >0.5 g/day. We also propose treatment with corticosteroids for patients with proteinuria >1 g/day and/or mesangial hypercellularity.

Conclusion

The formation of treatment guidelines for patients transitioning from pediatric to adult nephrology care is paramount.

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Data Availability

Not applicable.

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Authors and Affiliations

  1. Division of Nephrology and Hypertension, University of Colorado-Denver, Aurora, USA

    Angelina Dixon & Jessica Kendrick

  2. Division of Pediatric Nephrology, Children’s Hospital Colorado, Aurora, USA

    Angelina Dixon & Eliza Blanchette

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Dixon, A., Blanchette, E. & Kendrick, J. A lack of KDIGO guidelines for adolescents and young adults with IgA nephropathy. Pediatr Nephrol 39, 297–304 (2024). https://doi.org/10.1007/s00467-023-06027-4

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