Abstract
<h3>Background</h3> Nephritis is a recognised complication of IgA vasculitis (IgAV, Henoch-Schoenlein purpura, HSP) and contributes to 1–2% of all chronic kidney disease (CKD). Improved detection and understanding of kidney inflammation may reduce irreversible kidney damage in IgA vasculitis nephritis (IgAV-N). <h3>Objectives</h3> The primary aim of this study was to perform a comprehensive systematic review to evaluate the current literature to identify promising urine biomarkers that can predict and assess the severity of kidney disease in children with IgAV. <h3>Methods</h3> A systematic literature review was performed using 4 search engines and a search term strategy with predefined inclusion and exclusion criteria. Promising biomarkers were divided in terms of clinical or pre-clinical and described using statistical significance and area under the curve (AUC) values. <h3>Results</h3> 121 studies were identified and thirteen were eligible for inclusion. A total of 2,446 paediatric patients were included; 51% male, median age 7.9 years (range not available). This comprised of healthy controls (n=761), children with IgAV-N (n=1,236) and children with IgAV without nephritis (IgAV-noN, n=449). The clinical markers for assessing severity of nephritis, 24-hour protein quantity, urine protein:creatinine ratio were both acceptable (AUC <0.8) and urinary albumin concentration (Malb) performed well (AUC 0.81–0.98). The most promising pre-clinical urinary biomarkers were kidney injury molecule-1 (KIM-1) (AUC 0.93), monocyte chemotactic protein-1 (MCP-1) (AUC 0.83), N-acetyl-beta-glucosaminidase (NAG) (0.76–0.96), and angiotensinogen (AGT) (no AUC available). <h3>Conclusions</h3> Further longitudinal studies are needed to assess whether these biomarkers enhance standard of care in the management of IgAV-N.
Highlights
The NHS East of England guideline regarding administration of oxygen to infants (PNPG0161) was revised in 2019. It details the oxygen saturation target range and pulse oximetry monitoring alarm limits required by infants depending on their gestational age and comorbidities
Departmental teaching was organised regarding the content of the guideline and we introduced a sticker into the oxygen section of the drug charts
The unit remained consistent in monitoring 100% of infants receiving oxygen, the rate of infants below 34 weeks gestation on continuous pulse oximetry fell to 95%
Summary
Nephritis is a recognised complication of IgA vasculitis (IgAV, Henoch-Schoenlein purpura, HSP) and contributes to 1–2% of all chronic kidney disease (CKD). Objectives The primary aim of this study was to perform a comprehensive systematic review to evaluate the current literature to identify promising urine biomarkers that can predict and assess the severity of kidney disease in children with IgAV. A total of 2,446 paediatric patients were included; 51% male, median age 7.9 years (range not available). This comprised of healthy controls (n=761), children with IgAV-N (n=1,236) and children with IgAV without nephritis (IgAV-noN, n=449). The most promising pre-clinical urinary biomarkers were kidney injury molecule-1 (KIM-1) (AUC 0.93), monocyte chemotactic protein-1 (MCP-1) (AUC 0.83), N-acetyl-beta-glucosaminidase (NAG) (0.76–0.96), and angiotensinogen (AGT) (no AUC available). Conclusions Further longitudinal studies are needed to assess whether these biomarkers enhance standard of care in the management of IgAV-N
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