Biomarkers of kidney involvement in paediatric IgA vasculitis: a systematic review and meta-analysis.
Mădălina Andreea Beldie, Márk Viktor Hernádfői, Karen Krisztina Fazekas et al.
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In 30 seconds
This systematic review and meta-analysis assessed serum and urinary biomarkers for predicting IgA vasculitis nephritis in children with IgA vasculitis. It included 129 studies and 23,726 patients, using random-effects models to compare biomarker levels in patients with and without nephritis. Neutrophil-to-lymphocyte ratio was higher in patients with nephritis overall (0.48; 95% CI 0.04-0.93), although results differed by population. A positive faecal occult blood test was associated with increased odds of kidney involvement (OR 2.04; 95% CI 1.05-3.96). The authors concluded that clinically actionable predictors remain lacking.
Key findings
- Neutrophil-to-lymphocyte ratio was higher with nephritis overall (0.48; 95% CI 0.04-0.93), with differing results in Turkish and Chinese subgroups.
- In the Turkish subgroup, platelet-to-lymphocyte ratio was higher with nephritis (21.9; 95% CI 9.64-34.16); the Chinese subgroup estimate was - 6.75; 95% CI - 11.27-2.22.
- A positive faecal occult blood test was associated with increased odds of kidney involvement (OR 2.04; 95% CI 1.05-3.96).
Why it matters
Kidney involvement in paediatric IgA vasculitis may be diagnosed late, so accessible markers that help identify risk could support earlier assessment. This synthesis finds associations for blood-cell ratios and faecal occult blood testing, but variation across populations and study methods means these results do not establish reliable individual prediction.
What to keep in mind
Evidence was predominantly retrospective, diagnostic accuracy measures were reported infrequently, and substantial heterogeneity in nephritis definitions, measurement methods and populations limits firm conclusions about biomarker performance.