اعتلال الكلى بـIgA عند الأطفال دون الثامنة عشرة — عندما لا يُحقق حصار RAS أهداف البيلة البروتينية

References

1. In this guideline, we define children as those aged <18 years, but it is acknowledged that postpubertal children may in some respects have a similar course and response to treatment as adults with IgAN.
2. Systemic oral glucocorticoids are used in selected settings in children with clinical risk of progression, as evidenced by one of the following: (i) PCR 500–1000 mg/g (50–100 mg/mmol) despite 3–6 months of RASi, (ii) PCR >1000 mg/g (>100 mg/mmol) despite 4 weeks of RASi, or (iii) active MEST-C scores (≥1 of the following scores: M1, E1, S1 with podocyte lesions, and/or C1) and/or PCR consistently (≥2 measurements 1–2 weeks apart over 2–3 weeks) >1000 mg/g (100 mg/mmol) in addition to RAS blockade.
3. Duration of treatment is not established, but usually 2 mg/kg/d (maximum 60 mg/m²/d) of oral prednisone/prednisolone (or equivalent) for a maximum of 4 weeks followed by alternate-day dosing tapered over 5–6 months is given.
4. Lower doses, such as those emerging from the adult Therapeutic Effects of Steroids in IgA Nephropathy Global (TESTING) trial (0.4 mg/kg/d of prednisone/prednisolone [or equivalent] for 2 months, tapering over 6 months) should be considered.
5. Aim for proteinuria ≤200 mg/d (≤400 mg/1.73 m² per day) or PCR ≤200 mg/g (≤20 mg/mmol).