Effect of medical therapy of juvenile idiopathic arthritis on glomerular filtration rate in children
DOI:
https://doi.org/10.15574/SP.2021.120.30Keywords:
children, juvenile idiopathic arthritis, glomerular filtration rate, cystatinAbstract
Juvenile idiopathic arthritis (JIA) is a chronic disease requiring years of therapy with non-steroidal anti-inflammatory drugs (NSAIDs), immunosuppressants, cytostatics, immunobiological agents. The aforementioned drugs, namely NSAIDs and cytostatics are potentially nephrotoxic.
The purpose of the study was to determine the effect of drug therapy in children with JIA on GFR using the Cystatin C$based equation and the Hoek formula based on serum cystatin C testing.
Materials and methods. 80 children with JIA participated in the study. The age of subjects was 10.4±4.41 (10.6–15.0) years. All children received methotrexate as a base drug. At the moment of examination 22 children received NSAIDs, 25 children received immunobiological preparations. Serum cystatin C content was determined by enzyme immunoassay. The Cystatin C-based equation 2012 and Hoek formulas were used to set the GFR by serum cystatin C levels.
Results. Non-steroidal anti-inflammatory drugs led to a decrease in GFR as found by both the Cystatin C-based equation 2012 and the Hoek formula. The incidence of GFR reduction in patients treated with NSAIDs using the Cystatin C-based equation 2012 was 100%, and using the Hoek formula was 81.8%. The use of NSAIDs in children with JIA is a risk factor for the development of reduced GFR calculated by the Hoek formula. The incidence of reduced GFR in children with NSAID use was 54.5%, 6.7 times greater than in those without NSAIDs (OR=12.9; CI: 3.76–44.25; p<0.001). There was a low chance of a Hoek formula decrease in GFR in children with JIA who received immunobiological therapy 9.1% vs 46.8% (OR=0.11; CI: 0.03–0.42; p<0.001).
Conclusions. Use of NSAIDs in children with JIA was more often associated with a reduction in GFR: by Cystatin C — based equation 2012 in 100% of cases p<0.01, by Hoek in 81.8%, p<0.001. The average of GFR was significantly lower in children treated with NSAIDs than in children without NSAIDs. Immunobiological therapy had a positive effect on the GFR value. The frequency of a decrease in GFR was significantly lower in the children treated with immune-biological therapy compared with those without immunobiological therapy 9.1% vs 46.8% (OR=0.11; CI: 0.03–0.42; p<0.001).
The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.
No conflict of interest was declared by the author.
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