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

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IgA nephropathy in children: before and after the start of COVID-19
Pediatric Nephrology ( IF 3 ) Pub Date : 2023-11-10 , DOI: 10.1007/s00467-023-06196-2
Esther Huimin Leow ₁ , Siew Le Chong ₁ , Celeste Jia Ying Yap ₁ , Sing Ming Chao ₁ , Indra Ganesan ₁ , Fan Wang ₂ , Yong Hong Ng ₁

Affiliation

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.

Graphical abstract

中文翻译：

儿童 IgA 肾病：COVID-19 爆发之前和之后

背景

我们描述了在 COVID-19 出现之前和之后诊断出的 IgA 肾病 (IgAN) 儿童的临床病程。我们假设 COVID-19 疫苗接种和/或感染导致更多儿童出现临床 IgAN。

方法

我们对 2014-2020 年（第 1 期）和 2021-2022 年（第 2 期）经肾活检诊断为 IgAN 的儿童进行了回顾性队列研究。对第 1 期和第 2 期诊断的患者以及肾活检有和没有慢性变化的患者之间的基线特征、临床表现、检查和治疗进行了比较。使用 Wilcoxon 秩和检验比较连续变量。使用 χ2 或 Fisher 精确检验比较分类变量。

结果

19 名 IgAN 儿童通过肾活检确诊，其中 10 名患者在第 1 期，9 名患者在第 2 期（第 1 期和第 2 期分别平均每年 1-2 名患者和 4-5 名患者）。肾活检最常见的指征是蛋白尿，患者肾活检时尿蛋白/肌酐比为 1.4（四分位距 [IQR] 1.2–9.0）vs. 0.8 (IQR 0.6–1.5) g/g ( p = 0.064)分别在第 1 期和第 2 期。两个时期的临床过程相似。没有患者需要急性或慢性肾脏替代治疗。