Diagnosis and Treatment of Immune-Mediated Kidney Diseases - Episode 6
Carla M. Nester, MD, MSA, FASN, discusses the differences of C3G in the pediatric versus adult population.
Jonathan Barratt, PhD, FRCP: I'm glad we've got Sanjeev here and we'll come to the kidney biopsy in a short while. But just a final question, again, as an adult nephrologist, I'm fascinated by how children behave. I only see children who transition through to the adult clinic. Do children behave in a different way to adults in terms of this disease, or do you think there are similarities here?
Carla M. Nester, MD, MSA, FASN: It depends on which cohort you look at; we used to believe that children were going to have the most aggressive disease, and the variant called dense deposit disease was going to be the most aggressive disease. But it turns out that regardless of whether it's dense deposit disease or C3 glomerulonephritis, the disease can be very active. And that's one of the unmet needs for a practicing glomerular physician is, is this idea of not knowing who or how to tell who is going to do very poorly. Who requires the most aggressive of your therapies? I would say that children present very similar glomerular diseases, except for they might be a little bit more likely to have nephrotic syndrome. They are certainly more likely to be damaged by the loss of their kidney function. Not only because they have growth to take care of, but they have all the normal body functions they need to take care of, but also because they're going to be headed for 1, maybe 2, even more transplants, frankly, because of the sheer risk for recurrence.
Jonathan Barratt, PhD, FRCP: And with children affected both with IgA nephropathy and C3G, we think we focus very much on the medical aspects of these diseases, but clearly, this impacts on education, it impacts on social skill development, it impacts on whole range of different things that as adult nephrologists, we don't tend to concentrate so much on. What kinds of experience have you had of that?
Carla M. Nester, MD, MSA, FASN: That's a very good point that we shouldn't forget, but we sometimes do. It affects the patient's self-worth if you - they worry that I've got this very rare renal disease, or I've got this untreatable renal disease. And I think that with the younger mind not being able to completely understand what impact this may have on them, it can be very traumatic for them, like you said, socially or even within their normal growth patterns, if you will.
Transcript Edited for Clarity