Diagnosis and Treatment of Immune-Mediated Kidney Diseases - Episode 14

Diagnosing C3G in pediatric patients

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Carla M. Nester, MD, MSA, FASN, discusses the approach to diagnostic testing in pediatric patients suspected of C3G.

Jonathan Barratt, PhD, FRCP: Carla, in children is that the same approach that you would take or would you- because I know when you see disease in children, you're thinking far more about genetic diseases than potentially we do in adults?

Carla M. Nester, MD, MSA, FASN: I would say yes, I think in children we follow the same pattern. If I back up and talk about post-infectious glomerulonephritis it is the most common glomerulonephritis in children. As was talked about, if nephrologists are going to be seeing glomerulonephritis in children it's going to be post-infectious glomerulonephritis. Of course, we consider that a setting where the complement, the alternative pathway for instance is active but not necessarily dis-regulated. They will in fact have an active complement system, and may very well have a low C3, sometimes a low C4 also by the way. It depends on what the infection was that may have triggered it but within 12 weeks, according to our most recent consensus report it would say if they normalized the complement values within that 12 weeks it's safe to keep them as post-infectious glomerulonephritis. If they don't normalize their complement studies, then that's the time you can reassign the diagnosis to C3 glomerulopathy. That's critical because if you're the average person who's thinking this is just post-infectious and you don't follow them out to 12 weeks and make sure that they truly have gotten better, then in fact that would be a patient that you would diagnose late because it would be their next episode of glomerulonephritis that you would be waiting to happen before you would actually pick them up. In children that's a problem. Second episodes, third episodes etcetera, they are going to damage the kidney.

Transcript Edited for Clarity