Abstract：
BACKGROUND: IgA nephropathy (IgAN) is one of the most prevalent primary glomerular diseases in children and adolescents. In 2021, The Kidney Disease: Improving Global Outcomes (KDIGO) released Clinical Practice Guidelines for the Management of Glomerular Diseases as an update to the 2012 guidelines. However, the lack of available evidence for the treatment of IgAN in children has led to an absence of treatment recommendations.
METHODS: We present the case of a 19-year-old male with IgAN who was lost to follow-up after an appointment at a children\'s hospital 3 years prior. He presents for care at an adult hospital after running out of his medications for many months. He is found to have an elevated blood pressure of 152/97 and an elevated creatinine at 0.8 mg/dL.
CONCLUSIONS: There is not only a need for treatment guidelines for IgAN in pediatric patients, but also a need for guidelines for adolescent patients with IgAN as they transition from pediatric to adult care. Therefore, we review the KDIGO treatment guidelines for adults with IgAN and the treatment evidence for children with IgAN and discuss the management dilemma that exists for adolescents and young adults (AYA) with IgAN. Specifically, we propose renin-angiotensin-aldosterone blockade (RASB) treatment, irrespective of blood pressure, for AYA with proteinuria >0.5 g/day. We also propose treatment with corticosteroids for patients with proteinuria >1 g/day and/or mesangial hypercellularity.
CONCLUSIONS: The formation of treatment guidelines for patients transitioning from pediatric to adult nephrology care is paramount.
METHODS: We present the case of a 19-year-old male with IgAN who was lost to follow-up after an appointment at a children\'s hospital 3 years prior. He presents for care at an adult hospital after running out of his medications for many months. He is found to have an elevated blood pressure of 152/97 and an elevated creatinine at 0.8 mg/dL.
CONCLUSIONS: There is not only a need for treatment guidelines for IgAN in pediatric patients, but also a need for guidelines for adolescent patients with IgAN as they transition from pediatric to adult care. Therefore, we review the KDIGO treatment guidelines for adults with IgAN and the treatment evidence for children with IgAN and discuss the management dilemma that exists for adolescents and young adults (AYA) with IgAN. Specifically, we propose renin-angiotensin-aldosterone blockade (RASB) treatment, irrespective of blood pressure, for AYA with proteinuria >0.5 g/day. We also propose treatment with corticosteroids for patients with proteinuria >1 g/day and/or mesangial hypercellularity.
CONCLUSIONS: The formation of treatment guidelines for patients transitioning from pediatric to adult nephrology care is paramount.
摘要：
背景：IgA肾病（IgAN）是儿童和青少年中最常见的原发性肾小球疾病之一。2021年，肾脏疾病：改善全球结果（KDIGO）发布了肾小球疾病管理临床实践指南，作为2012年指南的更新。然而,缺乏治疗儿童IgAN的现有证据导致缺乏治疗建议.
方法：我们介绍了一例19岁男性IgAN患者，3年前在儿童医院预约随访失败。在用完药物几个月后，他在一家成人医院接受护理。发现他的血压升高为152/97，肌酐升高为0.8mg/dL。
结论：不仅需要儿童IgAN的治疗指南，但也需要为青少年IgAN患者提供指南，因为他们从儿科过渡到成人护理。因此,我们回顾了KDIGO成人IgAN治疗指南和儿童IgAN治疗证据,并讨论了青少年和青少年IgAN患者(AYA)存在的治疗困境.具体来说,我们建议肾素-血管紧张素-醛固酮阻断（RASB）治疗，不管血压如何,对于蛋白尿>0.5g/天的AYA。我们还建议使用皮质类固醇治疗蛋白尿>1g/天和/或肾小球系膜细胞过多的患者。
结论：为从儿科到成人肾病的患者制定治疗指南至关重要。
方法：我们介绍了一例19岁男性IgAN患者，3年前在儿童医院预约随访失败。在用完药物几个月后，他在一家成人医院接受护理。发现他的血压升高为152/97，肌酐升高为0.8mg/dL。
结论：不仅需要儿童IgAN的治疗指南，但也需要为青少年IgAN患者提供指南，因为他们从儿科过渡到成人护理。因此,我们回顾了KDIGO成人IgAN治疗指南和儿童IgAN治疗证据,并讨论了青少年和青少年IgAN患者(AYA)存在的治疗困境.具体来说,我们建议肾素-血管紧张素-醛固酮阻断（RASB）治疗，不管血压如何,对于蛋白尿>0.5g/天的AYA。我们还建议使用皮质类固醇治疗蛋白尿>1g/天和/或肾小球系膜细胞过多的患者。
结论：为从儿科到成人肾病的患者制定治疗指南至关重要。
