Treatment of IgA nephropathy in children: a land without KDIGO guidance

Area of Science:

• Pediatric Nephrology
• Glomerular Diseases
• Immunoglobulin A Nephropathy

Background:

• IgA nephropathy (IgAN) in children is a complex condition with varied outcomes, not a rare, benign disease.
• Treatment decisions for IgAN hinge on individual progression risk.
• Existing Kidney Disease: Improving Global Outcomes (KDIGO) guidelines for adults are often applied to children, despite limited pediatric evidence.

Purpose of the Study:

• To evaluate the suitability of current KDIGO guidelines for treating IgAN in children.
• To highlight the need for pediatric-specific prediction models for IgAN progression.
• To advocate for personalized treatment strategies based on identified risk levels in pediatric IgAN.

Main Methods:

• Review of existing KDIGO guidelines and controversies conference statements.
• Analysis of the evidence base for IgAN treatment in pediatric populations.
• Discussion of the limitations of adult-based risk stratification in children.

Main Results:

• Current KDIGO guidelines are poorly adapted for treating IgAN in children due to scarce pediatric-specific evidence.
• Risk factors for progression in children may differ from adults, making adult schedules unsuitable.
• There is a significant gap in pediatric-focused prediction models for IgAN.

Conclusions:

• Pediatric IgAN management requires distinct approaches from adult guidelines.
• Development of novel prediction models is crucial for identifying children at risk of IgAN progression.
• Personalized treatment strategies, including targeted therapies, are needed for improved pediatric IgAN outcomes.