Child Kidney Dis.  2023 Dec;27(2):55-63. 10.3339/ckd.23.009.

Introducing the general management of glomerular disease from a pediatric perspective based on the updated KDIGO guidelines

• Lim SH

• KMID: 2549734
• DOI: http://doi.org/10.3339/ckd.23.009

Abstract

In 2021, a new chapter on the general management of glomerulonephritis (GN) was added to the Kidney Disease: Improving Global Outcomes (KDIGO). It emphasizes the importance of early general management of GN for improving long-term kidney outcomes and prognosis. The chapter introduces the management of glomerular diseases in 18 subchapters. Here, kidney biopsy for the diagnosis and evaluation of kidney function and the management of complications, such as hypertension, infection, and thrombosis, are presented. Moreover, the adverse effects of glucocorticoids and immunosuppressive therapy, which are commonly used drugs for glomerular disease, are mentioned, and a guideline for drug selection is presented. Each subtheme focused on items reflecting the interpretation of the “practice points” of the expert working group are introduced. In this review of the general treatment for GN in the KDIGO guidelines, excluding pregnancy and reproductive health, we focused on and compared various references pertaining to pediatric GN management.

Keyword

Adult; Child; Glomerulonephritis; Guideline

Reference

References

1. Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. KDIGO 2021 clinical practice guideline for the management of glomerular diseases. Kidney Int. 2021; 100(4S):S1–276.

2. Pettit C, Kanagaratnam R, Coughlan F, Graf N, Hahn D, Durkan A. Kidney biopsy adequacy and complications in children: does technique matter? Eur J Pediatr. 2022; 181:2677–84.

3. Ding JJ, Lin SH, Huang JL, Wu TW, Hsia SH, Lin JJ, et al. Risk factors for complications of percutaneous ultrasound-guided renal biopsy in children. Pediatr Nephrol. 2020; 35:271–8.

4. Jang KM, Cho MH. Clinical approach to children with proteinuria. Child Kidney Dis. 2017; 21:53–60.

5. Antunes VV, Veronese FJ, Morales JV. Diagnostic accuracy of the protein/creatinine ratio in urine samples to estimate 24-h proteinuria in patients with primary glomerulopathies: a longitudinal study. Nephrol Dial Transplant. 2008; 23:2242–6.

6. Leung AK, Wong AH, Barg SS. Proteinuria in children: evaluation and differential diagnosis. Am Fam Physician. 2017; 95:248–54.

7. Pierce CB, Munoz A, Ng DK, Warady BA, Furth SL, Schwartz GJ. Age- and sex-dependent clinical equations to estimate glomerular filtration rates in children and young adults with chronic kidney disease. Kidney Int. 2021; 99:948–56.

8. Hoste L, Dubourg L, Selistre L, De Souza VC, Ranchin B, Hadj-Aissa A, et al. A new equation to estimate the glomerular filtration rate in children, adolescents and young adults. Nephrol Dial Transplant. 2014; 29:1082–91.

9. Pottel H, Hoste L, Dubourg L, Ebert N, Schaeffner E, Eriksen BO, et al. An estimated glomerular filtration rate equation for the full age spectrum. Nephrol Dial Transplant. 2016; 31:798–806.

10. Kohler H, Wandel E, Brunck B. Acanthocyturia: a characteristic marker for glomerular bleeding. Kidney Int. 1991; 40:115–20.

11. Hamadah AM, Gharaibeh K, Mara KC, Thompson KA, Lieske JC, Said S, et al. Urinalysis for the diagnosis of glomerulonephritis: role of dysmorphic red blood cells. Nephrol Dial Transplant. 2018; 33:1397–403.

12. Kaku Y, Ohtsuka Y, Komatsu Y, Ohta T, Nagai T, Kaito H, et al. Clinical practice guideline for pediatric idiopathic nephrotic syndrome 2013: general therapy. Clin Exp Nephrol. 2015; 19:34–53.

13. Gupta S, Pepper RJ, Ashman N, Walsh SB. Nephrotic syndrome: oedema formation and its treatment with diuretics. Front Physiol. 2019; 9:1868.

14. Bockenhauer D. Over- or underfill: not all nephrotic states are created equal. Pediatr Nephrol. 2013; 28:1153–6.

15. Polderman N, Cushing M, McFadyen K, Catapang M, Humphreys R, Mammen C, et al. Dietary intakes of children with nephrotic syndrome. Pediatr Nephrol. 2021; 36:2819–26.

16. Momoniat T, Ilyas D, Bhandari S. ACE inhibitors and ARBs: managing potassium and renal function. Cleve Clin J Med. 2019; 86:601–7.

17. Toblli JE, Bevione P, Di Gennaro F, Madalena L, Cao G, Angerosa M. Understanding the mechanisms of proteinuria: therapeutic implications. Int J Nephrol. 2012; 2012:546039.

18. Schmidt M, Mansfield KE, Bhaskaran K, Nitsch D, Sorensen HT, Smeeth L, et al. Serum creatinine elevation after renin-angiotensin system blockade and long term cardiorenal risks: cohort study. BMJ. 2017; 356:j791.

19. Stotter BR, Ferguson MA. Should ACE inhibitors and ARBs be used in combination in children? Pediatr Nephrol. 2019; 34:1521–32.

20. Bomback AS, Kshirsagar AV, Amamoo MA, Klemmer PJ. Change in proteinuria after adding aldosterone blockers to ACE inhibitors or angiotensin receptor blockers in CKD: a systematic review. Am J Kidney Dis. 2008; 51:199–211.

21. Zhang Z, Wu P, Zhang J, Wang S, Zhang G. The effect of statins on microalbuminuria, proteinuria, progression of kidney function, and all-cause mortality in patients with non-end stage chronic kidney disease: a meta-analysis. Pharmacol Res. 2016; 105:74–83.

22. Chapter 4: Pharmacological cholesterol-lowering treatment in children. Kidney Int Suppl (2011). 2013; 3:282–3.

23. Sunil B, Foster C, Wilson DP, Ashraf AP. Novel therapeutic targets and agents for pediatric dyslipidemia. Ther Adv Endocrinol Metab. 2021; 12:204201882110583.

24. Phan BA, Dayspring TD, Toth PP. Ezetimibe therapy: mechanism of action and clinical update. Vasc Health Risk Manag. 2012; 8:415–27.

25. Katzmann JL, Gouni-Berthold I, Laufs U. PCSK9 inhibition: insights from clinical trials and future prospects. Front Physiol. 2020; 11:595819.

26. Lin R, McDonald G, Jolly T, Batten A, Chacko B. A systematic review of prophylactic anticoagulation in nephrotic syndrome. Kidney Int Rep. 2019; 5:435–47.

27. Kerlin BA, Haworth K, Smoyer WE. Venous thromboembolism in pediatric nephrotic syndrome. Pediatr Nephrol. 2014; 29:989–97.

28. Andolino TP, Reid-Adam J. Nephrotic syndrome. Pediatr Rev. 2015; 36:117–26.

29. Park SJ, Shin JI. Complications of nephrotic syndrome. Korean J Pediatr. 2011; 54:322–8.

30. Leonard MB, Feldman HI, Shults J, Zemel BS, Foster BJ, Stallings VA. Long-term, high-dose glucocorticoids and bone mineral content in childhood glucocorticoid-sensitive nephrotic syndrome. N Engl J Med. 2004; 351:868–75.

31. Mauras N. Growth hormone therapy in the glucocorticosteroid-dependent child: metabolic and linear growth effects. Horm Res. 2001; 56 Suppl 1:13–8.

32. Sampathkumar K, Ramalingam R, Prabakar A, Abraham A. Acute interstitial nephritis due to proton pump inhibitors. Indian J Nephrol. 2013; 23:304–7.

33. Li Y, Xiong M, Yang M, Wang L, Nie S, Liu D, et al. Proton pump inhibitors and the risk of hospital-acquired acute kidney injury in children. Ann Transl Med. 2020; 8:1438.

34. Ueda N, Kuno K, Ito S. Eight and 12 week courses of cyclophosphamide in nephrotic syndrome. Arch Dis Child. 1990; 65:1147–50.

35. Sinha A, Bagga A. Rituximab therapy in nephrotic syndrome: implications for patients’ management. Nat Rev Nephrol. 2013; 9:154–69.

36. Labrosse R, Barmettler S, Derfalvi B, Blincoe A, Cros G, Lacombe-Barrios J, et al. Rituximab-induced hypogammaglobulinemia and infection risk in pediatric patients. J Allergy Clin Immunol. 2021; 148:523–32.

37. Uauy RD, Hogg RJ, Brewer ED, Reisch JS, Cunningham C, Holliday MA. Dietary protein and growth in infants with chronic renal insufficiency: a report from the Southwest Pediatric Nephrology Study Group and the University of California, San Francisco. Pediatr Nephrol. 1994; 8:45–50.

38. Wingen AM, Fabian-Bach C, Schaefer F, Mehls O. Randomised multicentre study of a low-protein diet on the progression of chronic renal failure in children. European Study Group of Nutritional Treatment of Chronic Renal Failure in Childhood. Lancet. 1997; 349:1117–23.

39. Shaw V, Polderman N, Renken-Terhaerdt J, Paglialonga F, Oosterveld M, Tuokkola J, et al. Energy and protein requirements for children with CKD stages 2-5 and on dialysis-clinical practice recommendations from the Pediatric Renal Nutrition Taskforce. Pediatr Nephrol. 2020; 35:519–31.