Immunosuppressive therapy for IgA nephropathy in children

Area of Science:

• Nephrology
• Pediatric Nephrology
• Immunology

Background:

• IgA nephropathy (IgAN) is the most common primary glomerulonephritis, characterized by heterogeneous presentations and significant morbidity.
• A substantial percentage of children with IgAN experience a decline in kidney function or kidney failure within 10 years.

Purpose of the Study:

• To evaluate the benefits and harms of immunosuppressive therapies for treating IgA nephropathy in pediatric patients.
• To synthesize evidence from randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs).

Main Methods:

• Searched the Cochrane Kidney and Transplant Register of Studies up to October 2023.
• Included RCTs and NRSIs comparing immunosuppressive therapies to placebo, no treatment, supportive care, or other interventions.
• Data extraction and risk of bias assessment were performed independently by two authors; meta-analyses were conducted using random effects models.

Main Results:

• The review included 13 studies with 686 participants (mostly children with mild IgAN); risk of bias was often unclear.
• Evidence regarding corticosteroid therapy's effect on proteinuria or estimated glomerular filtration rate (eGFR) decline in children with IgAN is of low certainty and uncertain.
• Other immunosuppressive agents, fish oil, vitamin E, and tonsillectomy showed uncertain effects on proteinuria or eGFR decline, with limited data on adverse events.

Conclusions:

• A significant lack of high-quality evidence exists for managing IgAN in children.
• Current evidence does not support the use of steroids, other immunosuppressants, or tonsillectomy to prevent eGFR decline or proteinuria in pediatric IgAN when added to supportive care.
• Findings are limited by small study sizes, low-quality evidence, and lack of assessment for harms, precluding generalization to severe or atypical IgAN cases.