New advances in pediatric nephrology: ESPN 2023 results

G.Yu. Zvenigorodska, Yu.O. Kislova, R.R. Andrunevich
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Abstract

On September 28 — October 1, 2023, the European Society for Paediatric Nephrology (ESPN) 55th Annual Meeting was held in Vilnius, Lithuania, where new achievements in the world of pediatric nephrology were presented. The program included 66 sessions with reports, continuing medical education courses, 117 invited speakers, meetings of working groups on various issues of pediatric nephrology were held, about 450 abstracts were printed and 292 poster presentations were discussed, inclu­ding two by authors from Ukraine. Courses for young doctors, preparing them for the international exam, and 5-minute reports by well-known specialists became interesting in the organization of continuing medical education, which significantly increased the amount of presented material. Among the innovative approaches in pediatric nephrology, the following drugs have been considered: finerenone (a selective non-steroidal mineralocorticoid receptor antagonist), sparsentan (an angiotensin/endothelin receptor antagonist) for Alport syndrome, focal segmental glomerulosclerosis, IgA nephropathy, dapagliflozin (a sodium-glucose cotransporter 2 inhibitor) for chronic kidney disease and pioglitazone for proteinuria. New approaches have been introduced: to IgA nephropathy — proteinuria control with angiotensin-converting enzyme inhibitors (ACEi), tonsillectomy, rituximab, eculizumab; to focal segmental glomerulosclerosis — plasmapheresis, rituximab (CD20), ofatumumab (CD20), abatacept (CD80/86), belatacept (CD80/86), daratumumab (CD38); to membranous nephropathy — proteinuria control with ACEi, rituximab, calcineurin inhibitors, glucocorticoids, cyclophosphamide; to membranoproliferative glomerulonephritis — proteinuria control with ACEi; to C3 glomerulopathy — proteinuria control with ACEi, eculizumab. Specific provisions of the BK polyomavirus (BKPyV) guidelines were considered, in particular, monthly screening for BKPyV-DNAemia in blood plasma is suggested until month 9, then every 3 months until month 24, after which additional screening every 3 months until the end of the third year after transplantation in pediatric kidney recipients (C, weak). In pediatric patients with stable renal function and high BKPyV-DNAemia, despite reduction in immunosuppressive therapy, we suggest consideration of renal allograft biopsy, as creatinine elevation may be decreased in children with significant renal involvement, including rejection (A, strong).
小儿肾脏病学的新进展:2023 年 ESPN 结果
2023 年 9 月 28 日至 10 月 1 日,欧洲儿科肾脏病学会(ESPN)第 55 届年会在立陶宛维尔纽斯举行,会上展示了世界儿科肾脏病学的新成就。会议日程包括 66 场报告会、继续医学教育课程、117 位特邀演讲人、关于小儿肾脏病学各种问题的工作组会议、约 450 份摘要印刷和 292 份海报展示讨论,其中包括来自乌克兰的两位作者。为年轻医生开设的国际考试备考课程和知名专家的 5 分钟报告成为继续医学教育的重要内容,大大增加了报告材料的数量。在小儿肾脏病学的创新方法中,考虑了以下药物:治疗阿尔波特综合征、局灶节段性肾小球硬化症、IgA肾病的非格列酮(一种选择性非甾体类矿物质皮质激素受体拮抗剂)、斯帕森坦(一种血管紧张素/内皮素受体拮抗剂)、治疗慢性肾脏病的达帕格列酮(一种钠-葡萄糖共转运体2抑制剂)和治疗蛋白尿的吡格列酮。新的方法已经推出:IgA肾病--使用血管紧张素转换酶抑制剂(ACEi)、扁桃体切除术、利妥昔单抗、依库珠单抗控制蛋白尿;局灶节段性肾小球硬化症--浆细胞溶解术、利妥昔单抗(CD20)、ofatumumab(CD20)、阿巴他赛普(CD80/86)、贝拉他赛普(CD80/86)、daratumumab(CD38);膜性肾病--使用 ACEi、利妥昔单抗、钙神经蛋白酶抑制剂、糖皮质激素、环磷酰胺控制蛋白尿;膜增生性肾小球肾炎--使用 ACEi 控制蛋白尿;C3 肾小球病--使用 ACEi、eculizumab 控制蛋白尿。考虑了 BK 多瘤病毒(BKPyV)指南的具体规定,特别是建议每月筛查血浆中的 BKPyV-DNAemia 直到第 9 个月,然后每 3 个月筛查一次直到第 24 个月,之后每 3 个月再筛查一次直到小儿肾脏受者移植后的第三年年底(C,弱)。对于肾功能稳定但 BKPyV-DNAemia 偏高的小儿患者,尽管免疫抑制疗法有所减少,我们仍建议考虑进行肾移植活检,因为肌酐升高可能会降低患儿的肾脏受累程度,包括排斥反应(A,强)。
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