There are a number of challenges associated with the treatment of children with IgA nephropathy (IgAN), including those related to their transition to adult care. Health care providers should consider their patients’ psychosocial concerns to help improve patient outcomes, as discussed at the National Kidney Foundation (NKF) 2024 Spring Clinical Meetings (SCM24).

Following these proceedings, featured expert Jai Radhakrishnan, MD, MS, was interviewed by Conference Reporter Associate Editor-in-Chief Rick Davis. Dr Radhakrishnan’s clinical perspectives are presented here.

IgAN presents somewhat differently in children than in adults. Children frequently present with synpharyngitic gross hematuria rather than asymptomatic hematuria, and IgA vasculitis is much more common in children and young adults compared with older adults. In addition, it can be difficult for children and young adults with IgAN because there are a lot of social and economic issues that surround having a chronic disease. There are also caregiver-related issues that need to be taken into consideration. Providing emotional support to parents and caregivers is as important as medically managing IgAN in younger patients. The importance of providing psychosocial support was a topic of discussion at SCM24 in a session titled “Kidney Team in Action – Pediatric Psychosocial Rounds: Providing Holistic Care to Patients and Families.”

Traditionally, pediatric nephrologists transition the follow-up of their patients at ages 18 through 21 years to adult nephrologists. However, some patients stay with the pediatric nephrologist even as they get older; in fact, I have seen 30- and 40-year-old patients remain in the care of their pediatric nephrologist. In the United States, some nephrologists are both pediatric and adult board certified, and these nephrologists continue treating such patients throughout the disease course.

The transition from pediatric to adult care in IgAN requires very careful planning. An important consideration is that young adults might feel alienated when they see an adult nephrologist provider since the practice styles may be quite different. Therefore, we take exceptional care to make sure that the patient is well covered during this transition period. If there is a need for a psychologist or a social worker to help them get through the transition phase, we frequently use them as well. Getting used to a new provider can be difficult, both for the young adult patient and for their parent(s) or caregiver(s). Further, caregivers of young patients with IgAN often face significant economic challenges related to the costs of ongoing medical treatments and frequent hospital visits. Additionally, the time and attention that are required for caregiving can lead to a loss of income or employment instability, further exacerbating financial strain.

Treatment strategies are somewhat different for children and adults with IgAN. There is a lack of randomized controlled trials and specific expert consensus guidelines for children with IgAN. Children more frequently receive immunosuppressant medications, especially glucocorticoids, as novel agents are not yet approved by the US Food and Drug Administration (FDA) for use in children with IgAN. It can be a bit of a culture shock because these adult patients were not previously eligible for the newer agents and are now suddenly able to avail them. So, when a patient reaches adulthood, their nephologist may say something like, “Okay, you’ve got this new therapy,” and the patient’s natural response may be, “How come I didn’t hear about this from my previous nephrologist?” One must explain to them that it is an FDA drug approval issue and has nothing to do with their pediatric nephrologist. I think that addressing these issues requires education and the early identification of problems, including psychosocial problems.