Abstract: FR-PO1067
Hypertension as a Modifiable Risk Factor in Children with Immune Complex MPGN and C3 Glomerulopathy
Session Information
- Pediatric Hypertension, AKI, Urologic Disorders
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1700 Pediatric Nephrology
Authors
- Kirpalani, Amrit, The Hospital for Sick Children, Toronto, Ontario, Canada
- Jawa, Natasha, The Hospital for Sick Children, Toronto, Ontario, Canada
- Greenbaum, Larry A., Emory University, Atlanta, Georgia, United States
- Smoyer, William E., Nationwide Children's Hospital, Columbus, Ohio, United States
- Licht, Christoph, The Hospital for Sick Children, Toronto, Ontario, Canada
Background
Hypertension is a known complication of complement-mediated renal disease and carries prognostic significance. Hypertension is associated with reduced GFR in children with immune-complex membranoproliferative glomerulonephritis (IC-MPGN). Similarly, hypertension has been associated with poor renal function and long-term outcome in patients with C3 glomerulopathy (C3G). This study explored the prevalence of hypertension in a IC-MPGN/C3G cohort.
Methods
Renal biopsy reports of 45 patients <18 years of age (originally diagnosed as MPGN between 2003 and 2012) across three centers were reviewed. Patients were re-classified as either IC-MPGN or C3G in 2019 based on consensus criteria. Demographic, clinical, and biochemical results were collected at enrollment and retrospectively at disease onset. Data were analyzed using Fisher’s exact test. Hypertension was defined as blood pressure > 95th percentile for age, sex, and height.
Results
19 of 45 (42%) of patients were diagnosed with hypertension at disease onset; only 2 of 19 (10%) resolved by the time of enrollment (mean 4 years later). 27 of 45 (60%) required antihypertensive medication at disease onset (mean 2.3 medications per patient); the same number (60%) required ongoing antihypertensive support at enrollment (mean 1.7 medications per patient). 9 of 27 (33%) required multiple antihypertensive medications.
Baseline demographics, clinical and biochemical parameters, incidence of hypertension, and antihypertensive use were similar between C3G and IC-MPGN patients (P>0.05).
Specifically, the use of angiotensin-converting enzyme inhibitors (86% vs. 76%, P=0.66) was the same in both groups, and though proteinuria improved significantly from disease onset to the time of study enrollment, hypertension continued to require treatment.
Conclusion
The incidence of hypertension in both pediatric C3G and IC-MPGN is similar to previously reported data. Interestingly, resolution of hypertension was low in this cohort (10%), and many patients (33%) required multiple antihypertensive medications. These data suggest that more aggressive hypertension management may be required and may potentially help to improve the long-term outcomes of children with C3G and IC-MPGN. The prognostic relevance of persistent hypertension in these diseases should be further studied.