International IgAN Prediction Tool post-biopsy – Pediatric

The concept of IgA nephropathy (IgAN) as a benign disease in children was based on the uncommon progression to kidney failure during the pediatric age range. However, 20% of children followed for several decades into adulthood experience a 50% decline in estimated glomerular filtration rate (eGFR) or end-stake kidney disease (ESKD) In 2019, the International IgAN Prediction Tool was designed to be used in adults at the time of biopsy to predict the risk of a 50% decline in eGFR or ESKD using readily available clinical predictor variables and the MEST histology scores¹¹. The adult Prediction Tool has subsequently undergone additional external validation and is now the recommended method for risk stratification in the 2021 KDIGO guidelines^12-15. To facilitate risk stratification in children, in 2021 we generated the pediatric Prediction Tool by updating the adult models so that they can be specifically used in children at the time of biopsy to predict the risk of a 30% decline in eGFR or ESKD¹². An international multi-ethnic cohort of 947 children with biopsy-proven IgAN and frequent follow-up into adulthood was used to update the adult post-biopsy Prediction Tool models so that they can be applied in children at a time point one or two years after biopsy to predict individual-level risk of a 30% decline in eGFR or ESKD. Clinicians face the challenge of not only accurately measuring blood loss but also understanding its clinical significance for each expectant mother. A crucial piece of information is knowing a patient's peripartum circulating blood volume, as it enables us to interpret hemorrhage severity correctly and provide appropriate resuscitation.