Progression of chronic kidney disease in children with glomerulopathy

BACKGROUND. Of particular scientific and practical importance are studies aimed at assessing the clinical features of the course and morphological signs of nephrotic and nephritic syndromes in children with chronic kidney diseases of the first and second stages. THE AIM: to assess the rate of progression of glomerulopathy in children depending on the treatment regimen.

PATIENTS AND METHODS. 238 children aged 1–18 years with an established nosological diagnosis of kidney damage at various stages of CKD were examined, hospitalized for treatment in the Department of nephrology at the clinic of the Tashkent  Pediatric Medical Institute in the period 2010-2022 and the National Children's Medical Center from 2021–2023.

RESULTS. Children with CKD were divided into two subgroups: 146 children with nephrotic syndrome (steroid-sensitive, steroid-resistant or often recurrent) and 92 children with nephritic syndrome. More than half of the children have glomerulonephritis with minimal changes. In 25.4 % of cases, they were insensitive to steroid therapy. Among patients with nephritic syndrome, 46 % had IgA nephropathy. In dynamics, the most unfavorable picture was formed in children with focal segmental glomerulosclerosis. After 12 years of follow-up, 41.7 % of them developed terminal renal failure. The least effective treatment was noted with the use of cyclophosphamide, the best with the combination of tacrolimus with mycophenolate mofetil.

CONCLUSION. Treatment regimens for children with glomerulopathy are still far from perfect.

1. Smirnov AV, Shilov EM, Dobronravov VA et al. National guidelines. chronic kidney disease: basic principles of screening, diagnosis, prevention and treatment approaches. Nephrology (Saint-Petersburg) 2012;16(1):89–115. (In Russ.) https://doi.org/10.24884/1561-6274-2012-16-1-89-115

2. Shvetsov MU, Bobkova IN, Collina IP, Kamyshova EU; EM. Shilov, ed. Modern principles of diagnosis and treatment of chronic kidney disease: a methodological guide for doctors. Saratov, 2011

3. Coresh J, Stevens L, Levey AS. Chronic kidney disease is common: what do we do next? Nephrol Dial Transplant 2008; (23):1122–1125. doi: 10.1093/ndt/gfn117

4. El-Nahas АМ, Bello AK. Chronic kidney disease: the global challenge. Lancet 2005; (365):331–340

5. Ivanov DD. Chronic kidney disease and chronic renal failure in children. Nephrology (Saint-Petersburg) 2006;10(3):123–126. (In Russ.) https://doi.org/10.24884/1561-6274-2006-10-3-123-126

6. Alizada U, Sauleau EA, Krummel T et al. the REIN registry. Effect of emergency start and central venous catheter on outcomes in incident hemodialysis patients: a prospective observational cohort. J Nephrol 2022;35(3):977–988. https://doi.org/10.1007/s40620-021-01188-7

7. Capolongo G, Capasso G, Viggiano D. A Shared Nephroprotective Mechanism for Renin-Angiotensin-System Inhibitors, Sodium-Glucose Co-Transporter 2 Inhibitors, and Vasopressin Receptor Antagonists: Immunology Meets Hemodynamics. Int J Mol Sci 2022;23(7):3915. https://doi.org/10.3390/ijms23073915

8. Tsukamoto S, Okami N, Yamada T et al. Prevention of kidney function decline using uric acid-lowering therapy in chronic kidney disease patients: a systematic review and network meta-analysis. Clin Rheumatol 2022;41(3):911–919. https://doi.org/10.1007/s10067-021-05956-5

9. Sandino J, Cordero Garcia-Galán L, Aubert Girbal L et al. Anything New in the Treatment of Obesity in Obese Patients with CKD? Nephron 2022:1–8. https://doi.org/10.1159/000524201

10. Nephrotic syndrome in children: Prediction of histopathology from clinical and laboratory characteristics at time of diagnosis. A report of the International Study of Kidney Disease in Children. Kidney Int 1978;13:159–165

11. McKinney PA, Feltbower RG, Brocklebank JT et al. Pediatr. Nephrol 2001;16(12):1040–1044

12. Niaudet P. Steroid-sensitive nephrotic syndrome in children. In: Avner ED, Harmon WE, Neasden P, ed. Paediatric Nephrology. 1st ed. Philadelphia, 2004, 543–556

13. International Study of Kidney Disease in Children Nephrotic syndrome in children: A randomized controlled trial comparing two prednisolone regimens in steroid-responsive patients who relapse early. J Pediatr 1982;95:239–243

14. Cyclophosphamide treatment of steroid dependent nephrotic syndrome: Comparison of eight week with 12-week course. Report of Arbeitsgemeinschaft fuř Pädiatrische Nephrologie. Arch Dis Child 1987;62(11):1102–1106

15. Sumegi V, Haszon I, Bereczki C et al. Pediat Nephrol 2008;23:1085–1092

16. Kemper MJ, Altrogge H, Ludwig K et al. Pediatr Nephrol 2000;14:772–775