Optimization of IgA nephropathy treatment in children based on the clinical and morphological presentation

Mamatkulova F.B., Khamzaev K.A., Mamatkulov B.B.

1) Tashkent State Medical University, Tashkent, Uzbekistan; 2) National Children’s Medical Center, Tashkent, Uzbekistan

Background. IgA nephropathy (IgAN) is a chronic autoimmune kidney disease characterized by deposits of immunoglobulin A in the glomerular mesangium, leading to inflammation and progression of glomerulopathy. IgAN in children has a variable course, ranging from asymptomatic micro- or macrohematuria to severe proteinuria and chronic progression. Despite extensive study in adults, pediatric treatment algorithms remain insufficiently standardized due to limited high-quality evidence. Steroids and immunosuppressants are used based on clinical experience and small studies, often without considering the morphological features of renal tissue. However, the development of an optimized treatment algorithm based on the integration of clinical manifestations and morphological status of the kidneys in IgAN in children remains relevant.
Objective. Examination of the clinical presentation of IgA nephropathy in children and evaluation of the efficacy of steroids and alkylating agents depending on morphological activity.
Materials and methods. The study was conducted at the Nephrology Department of the National Children’s Medical Center in Tashkent. The sample included 73 children aged 4 to 16 years with biopsy-confirmed IgA nephropathy. Data collection covered the period 2022–2025. The sex ratio in the group was 47 boys and 26 girls. The key clinical and laboratory signs of the disease were edema, proteinuria, macro- and microhematuria, arterial hypertension, and decreased renal function. All children underwent traditional diagnostic tests: a complete blood count, a complete urinalysis, and serum urea, creatinine, and cystatin C levels, C-reactive protein, antistreptolysin-O, liver enzymes, blood electrolytes, and a coagulation profile. In addition to traditional tests, C3 and C4complement levels, ANA, and anti-ds DNA were assessed, and anti-neutrophil cytoplasmic antibodies (ANCA) were also measured in the blood.
Results. In children with low morphological activity (M0/E0, C0), steroid therapy resulted in complete remission in 80% of patients. With high activity (M1/E1, C1-2), complete remission was achieved in only 50% of cases, requiring the combined use of immunosuppressants. Cyclosporine demonstrated the greatest efficacy in children with significant proteinuria and high morphological activity, achieving complete remission in 60% of patients. Alkylating agents were effective in steroid-resistant patients, achieving complete or partial remission in 80% of cases with manageable side effects. Immunosuppressive regimens (mycophenolate mofetil, cyclosporine) enhanced the therapeutic effect, and alkylating agents showed benefit in steroid-resistant cases of IgAN in children.
Conclusion. The effectiveness of therapy in children with IgAN depends on clinical manifestations and glomerular morphological activity. Steroids remain the mainstay of therapy for low activity, while combination immunosuppressive therapy is necessary for high activity and significant proteinuria. Alkylating agents are suitable for severe forms but require careful monitoring of side effects. Our data support the need for an individualized approach to the treatment of IgA nephropathy in children, taking into account morphological changes. An individualized approach to therapy for children with IgA nephropathy based on clinical and morphological assessments can improve treatment efficacy, achieving high remission rates, reducing steroid doses, and minimizing side effects.

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About the Authors

Farangiz B. Mamatkulova – Doctoral Student at the National Children’s Medical Center. Address: 294 Parkent Street, Yashnabad District, Tashkent, Uzbekistan, 100171; e-mail: Mfarangiz23@gmail.com ORCID: 0009-0001-8223-7575
Komilzhon A. Khamzaev – Dr.Sci. (Med.), Associate Professor at the Department of Emergency Medicine and Disaster Medicine at Tashkent State Medical University.
Address: 2 Farobi Street, Almazar District, Tashkent, Uzbekistan, 100109; e-mail: alishersm@yahoo.com. ORCID: 0000-0001-6135-3254
Bakhrom B. Mamatkulov – Cand.Sci. (Med.), Associate Professor, Department of Emergency Medicine and Disaster Medicine, Tashkent State Medical University.
Address: 2 Farobi Street, Almazar District, Tashkent, Uzbekistan, 100109; email: bahrom-mamatkulov@mail.ru. ORCID: 0000-0003-1921-4458

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