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IgA nephropathy in children: before and after the start of COVID-19

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Abstract

Background

We describe the clinical course of children with IgA nephropathy (IgAN), diagnosed before and after the emergence of COVID-19. We hypothesized that COVID-19 vaccination and/or infection resulted in more children with IgAN to present clinically.

Methods

We conducted a retrospective cohort study of children with IgAN diagnosed on kidney biopsy from 2014–2020 (Period 1) and 2021–2022 (Period 2). Baseline characteristics, clinical presentation, investigations and treatments were compared between patients diagnosed in Period 1 and Period 2, as well as between patients with and without chronic changes on kidney biopsy. Continuous variables were compared using the Wilcoxon rank sum test. Categorical variables were compared using χ2 or Fisher exact tests.

Results

Nineteen children with IgAN were diagnosed by kidney biopsy, with 10 during Period 1 and 9 patients during Period 2 (an average of 1–2 patients/year and 4–5 patients/year in Periods 1 and 2, respectively). The most common indication for kidney biopsy is proteinuria with urine protein/creatinine ratio 1.4 (interquartile range [IQR] 1.2–9.0) vs. 0.8 (IQR 0.6–1.5) g/g (p = 0.064) at time of kidney biopsy for patients in Period 1 and 2, respectively. Clinical course was similar in both periods. No patient required acute or chronic kidney replacement therapy.

Conclusions

The rate of diagnosing children with IgAN was higher since the emergence of COVID-19, suggesting that COVID-19 may trigger an immune response responsible for IgAN, similar to other mucosal infections.

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Data availability

Data presented are available upon reasonable request.

References

  1. Coppo R (2019) Pediatric IgA nephropathy in Europe. Kidney Dis (Basel) 5:182–188

    Article  PubMed  PubMed Central  Google Scholar 

  2. Coppo R, Robert T (2020) IgA nephropathy in children and in adults: two separate entities or the same disease? J Nephrol 33:1219–1229

    Article  PubMed  Google Scholar 

  3. Sugiyama H, Yokoyama H, Sato H, Saito T, Kohda Y, Nishi S et al (2013) Japan Renal Biopsy Registry and Japan Kidney Disease Registry: Committee Report for 2009 and 2010. Clin Exp Nephrol 17:155–173

    Article  PubMed  Google Scholar 

  4. Cho BS, Hahn WH, Cheong HI, Lim I, Ko CW, Kim SY et al (2013) A nationwide study of mass urine screening tests on Korean school children and implications for chronic kidney disease management. Clin Exp Nephrol 17:205–210

    Article  CAS  PubMed  Google Scholar 

  5. Yoshikawa N, Ito H, Nakamura H (1988) IgA nephropathy in children from Japan. Clinical and pathological features. Child Nephrol Urol 9:191–199

    PubMed  Google Scholar 

  6. Lévy M, Gonzalez-Burchard G, Broyer M, Dommergues JP, Foulard M, Sorez JP et al (1985) Berger’s disease in children. Natural history and outcome. Medicine (Baltimore) 64:157–180

    Article  PubMed  Google Scholar 

  7. Southwest Pediatric Nephrology Study Group (1982) A multicenter study of IgA nephropathy in children. A report of the Southwest Pediatric Nephrology Study Group. Kidney Int 22(6):643–652

  8. Trimarchi H, Barratt J, Cattran DC, Cook HT, Coppo R, Haas M et al (2017) Oxford classification of IgA nephropathy 2016: an update from the IgA nephropathy classification working group. Kidney Int 91:1014–1021

    Article  PubMed  Google Scholar 

  9. Hanna C, Herrera Hernandez LP, Bu L, Kizilbash S, Najera L, Rheault MN et al (2021) IgA nephropathy presenting as macroscopic hematuria in 2 pediatric patients after receiving the Pfizer COVID-19 vaccine. Kidney Int 100:705–706

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Udagawa T, Motoyoshi Y (2022) Macroscopic hematuria in two children with IgA nephropathy remission following Pfizer COVID-19 vaccination. Pediatr Nephrol 37:1693–1694

    Article  PubMed  PubMed Central  Google Scholar 

  11. Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group (2021) KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Kidney Int 100(4S):S1–S276

    Google Scholar 

  12. Barbour SJ, Coppo R, Er L, Russo ML, Liu ZH, Ding J et al (2021) Updating the international IgA nephropathy prediction tool for use in children. Kidney Int 99:1439–1450

    Article  CAS  PubMed  Google Scholar 

  13. Schwartz GJ, Muñoz A, Schneider MF, Mak RH, Kaskel F, Warady BA et al (2009) New equations to estimate GFR in children with CKD. J Am Soc Nephrol 20:629–637

    Article  PubMed  PubMed Central  Google Scholar 

  14. Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR et al (2017) Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 140:e20171904

    Article  PubMed  Google Scholar 

  15. Zhang YM, Zhang H (2018) Insights into the Role of Mucosal Immunity in IgA Nephropathy. Clin J Am Soc Nephrol 13:1584–1586

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Zhang J, Cao J, Ye Q (2022) Renal side effects of COVID-19 vaccination. Vaccines (Basel) 10:1783

    Article  CAS  PubMed  Google Scholar 

  17. Ma Y, Xu G (2023) New-onset IgA nephropathy following COVID-19 vaccination. QJM 116:26–39

    Article  CAS  PubMed  Google Scholar 

  18. Coppo R, Lofaro D, Camilla RR, Bellur S, Cattran D, Cook HT et al (2017) Risk factors for progression in children and young adults with IgA nephropathy: an analysis of 261 cases from the VALIGA European cohort. Pediatr Nephrol 32:139–150

    Article  PubMed  Google Scholar 

  19. Cambier A, Rabant M, Peuchmaur M, Hertig A, Deschenes G, Couchoud C et al (2018) Immunosuppressive treatment in children with IgA nephropathy and the clinical value of podocytopathic features. Kidney Int Rep 3:916–925

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kamei K, Nakanishi K, Ito S, Saito M, Sako M, Ishikura K et al (2011) Long-term results of a randomized controlled trial in childhood IgA nephropathy. Clin J Am Soc Nephrol 6:1301–1307

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kawasaki Y, Maeda R, Kanno S, Suzuki Y, Ohara S, Suyama K et al (2017) Long-term follow up of pediatric immunoglobulin A nephropathy treated with tonsillectomy plus methylprednisolone pulse therapy. Pediatr Int 59:41–47

    Article  CAS  PubMed  Google Scholar 

  22. Yoshikawa N, Honda M, Iijima K, Awazu M, Hattori S, Nakanishi K et al (2006) Steroid treatment for severe childhood IgA nephropathy: a randomized, controlled trial. Clin J Am Soc Nephrol 1:511–517

    Article  CAS  PubMed  Google Scholar 

  23. Yoshikawa N, Ito H, Sakai T, Takekoshi Y, Honda M, Awazu M et al (1999) A controlled trial of combined therapy for newly diagnosed severe childhood IgA nephropathy. The Japanese Pediatric IgA Nephropathy Treatment Study Group. J Am Soc Nephrol 10:101–109

    Article  CAS  PubMed  Google Scholar 

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Funding

No funds, grants, or other support was received.

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Authors and Affiliations

  1. Paediatric Medicine, Nephrology Service, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore

    Esther Huimin Leow, Siew Le Chong, Celeste Jia Ying Yap, Sing Ming Chao, Indra Ganesan & Yong Hong Ng

  2. Nursing Clinical Services, KK Women’s and Children’s Hospital, Singapore, Singapore

    Fan Wang

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  1. Esther Huimin Leow
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  2. Siew Le Chong
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  3. Celeste Jia Ying Yap
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  6. Fan Wang
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  7. Yong Hong Ng
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Contributions

Esther Huimin Leow formulated the overarching research goals and aim, conducted the literature search, collected data, analyzed the data, wrote the initial draft, then reviewed and edited the manuscript. All other authors formulated the overarching research goals and aim, reviewed and edited the manuscript and provided supervision and mentorship.

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Correspondence to Esther Huimin Leow.

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Leow, E.H., Chong, S.L., Yap, C.J.Y. et al. IgA nephropathy in children: before and after the start of COVID-19. Pediatr Nephrol 39, 1161–1167 (2024). https://doi.org/10.1007/s00467-023-06196-2

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  • DOI: https://doi.org/10.1007/s00467-023-06196-2

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