Hydroxychloroquine use in pediatric IgA nephropathy

Area of Science:

• Pediatric Nephrology
• Immunology
• Pharmacology

Background:

• Adult IgA nephropathy shows potential benefit from hydroxychloroquine (HCQ).
• HCQ targets toll-like receptors implicated in IgA nephropathy pathogenesis.
• Childhood-onset IgA nephropathy (cIgAN) requires effective treatment options.

Purpose of the Study:

• To investigate the efficacy and safety of HCQ in pediatric patients with cIgAN.
• To assess the impact of HCQ on proteinuria and kidney function in children.
• To evaluate HCQ as an adjunctive therapy for steroid-sparing in cIgAN.

Main Methods:

• Retrospective multicenter cohort study of 16 children with biopsy-proven cIgAN.
• HCQ administered as adjunctive therapy for persistent proteinuria or steroid-sparing.
• Collected clinical, histological, urine protein-to-creatinine ratio (UPCR), and estimated glomerular filtration rate (eGFR) data.
• Compared kidney biopsies before and after HCQ initiation.

Main Results:

• Significant reduction in UPCR observed at 3, 6, 9, and 12 months post-HCQ initiation (50% decrease at 12 months).
• Estimated glomerular filtration rate (eGFR) remained stable throughout the follow-up period.
• Kidney biopsies showed stable or improved Oxford scores post-HCQ treatment.
• No HCQ-related complications were reported.

Conclusions:

• HCQ use in children with cIgAN is associated with sustained proteinuria reduction and stable kidney function.
• This study represents the first pediatric cohort data on real-world HCQ use in cIgAN.
• Findings support further prospective trials of HCQ as a safe adjunctive treatment for selected cIgAN cases.