Observational studyPediatric nephrology (Berlin, Germany)2026
Hydroxychloroquine use in pediatric IgA nephropathy.
Observational study in Pediatric nephrology (Berlin, Germany), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHydroxychloroquine (HCQ) has been identified as an interesting treatment option in adult IgA nephropathy. HCQ targets the active toll-like receptors in IgA nephropathy. The purpose of this study was to explore the effects and potential benefits of HCQ for childhood-onset IgA nephropathy (cIgAN).
methodsWe conducted a retrospective multicenter cohort study including 16 children with biopsy-proven cIgAN treated with HCQ in tertiary pediatric nephrology centers in Canada and France. HCQ was prescribed as an adjunctive therapy for persistent proteinuria despite standard-of-care treatment and/or with a steroid-sparing intent. Clinical and histological data were collected at baseline, and urine protein-to-creatinine ratios (UPCR) and estimated glomerular filtration rates (eGFR) were documented at HCQ initiation, 3, 6, 9, and 12 months of follow-up. Iterative biopsies before and after the introduction of HCQ (n = 8) were compared. Steroid exposure was assessed in both groups, and safety monitoring data for HCQ therapy were documented.
resultsMedian age was 12.74 [11.33-14.07] years, with 37.5% male participants. Most (15/16, 93.8%) participants received steroid therapy, and all (16/16, 100%) were treated with renin-angiotensin-aldosterone system blockers. HCQ was initiated within a median time of 519 [249-1016.5] days from initial diagnosis. UPCR at 3, 6, 9, and 12 months after HCQ initiation significantly decreased, both in absolute and relative metrics. A decrease of 50% was noted at 12 months of follow-up. eGFR remained stable over the follow-up period. Follow-up biopsies in the HCQ-treated group showed stability or improvement of the Oxford score. No complications of HCQ were documented.
conclusionsIn this first pediatric cohort reporting on real-life experience with HCQ, HCQ use was associated with a sustained reduction in proteinuria and stable kidney function in children with difficult-to-control cIgAN, with an excellent safety profile. Although causality cannot be inferred due to the observational design and concomitant therapies, these findings support further prospective evaluation of HCQ as a safe adjunctive treatment in selected cases of cIgAN.
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