IgA nephropathy (IgAN) in children is no longer considered a rare and benign disease but a nephritis with different presentations and various outcomes. The decision to initiate a treatment and the therapeutic choice depend on the individual risk of progression. The Kidney Disease: Improving Global Outcomes (KDIGO) clinical guidelines in 2012 considered that the risk factors for progression of IgAN were similar in both children and adults and suggested in some conditions to follow the adult schedules. In 2017 a KDIGO Controversies Conference on management and treatment of glomerular diseases decided not to include an update in children with IgAN since the level of evidence of treatments in children was too scarce. Children can follow the indications for adults as far as the disease is similar in the various ages. This review is aimed at discussing why the KDIGO guidelines are poorly suitable to treat children with IgAN, and there is a need to develop new prediction models for progression of IgAN in children to guide selection of the cases to be treated. The identification of different risk levels in children with IgAN may personalize the choice of available drugs and support the use of new targeted therapies.

儿童 IgA 肾病 (IgAN) 不再被认为是一种罕见的良性疾病，而是一种具有不同表现和各种结果的肾炎。开始治疗的决定和治疗选择取决于个体的进展风险。2012 年肾脏疾病：改善全球结果 (KDIGO) 临床指南认为儿童和成人 IgAN 进展的危险因素相似，并建议在某些情况下遵循成人时间表。2017 年关于肾小球疾病管理和治疗的 KDIGO 争议会议决定不包括 IgAN 儿童的更新，因为儿童治疗的证据水平太少。儿童可按照成人的适应症，只要各年龄段疾病相似即可。本综述旨在讨论为什么 KDIGO 指南不太适合治疗儿童 IgAN，需要开发新的儿童 IgAN 进展预测模型，以指导选择待治疗的病例。识别 IgAN 儿童的不同风险水平可能会个性化可用药物的选择并支持使用新的靶向治疗。