ABSTRACT
Objective:
To explore the related factors of poor prognostis in
children with Henoch-Sch?nlein
purpura nephritis (HSPN), and provide reference for predicting and improving the
prognosis of
children with HSPN.
Methods:
The clinical and pathological data of
children with HSPN hospitalized in the Department of
Nephrology,
Children's
Hospital Affiliated to
Capital Institute of
Pediatrics from May 2007 to June 2019 were retrospectively reviewed. According to the
prognosis, the
patients were divided into complete remission group and persistent abnormal group.
Results:
(1) Among 108 cases, there were 73
males and 35
females, with the
onset age ranging from 5 to 16 years and average age of (9.5±2.8) years. The interval
time from the first clinic in our
hospital to the last follow-up was 2-131 months, with average of 24.8 months. Renal involvement occurred in the
course of Henoch-Sch?nlein
purpura from 1 day to 51 months, and the renal
biopsy time was 5 days to 60 months after renal involvement. (2)
Hematuria with
proteinuria type and
nephrotic syndrome type were predominant, and there was no significant difference between the two groups. The proportion of gross
hematuria in the persistent abnormal group were significantly higher than that in the complete remission group (52.6% vs 31.4%, χ2=4.659, P=0.031). There were significant differences in
serum creatinine and
urea between the two groups (both P<0.05). The proportion of
hyperuricemia in the persistent abnormal group was higher than that in the complete remission group (39.5% vs 21.4%, χ2=3.998, P=0.046). After clinical
treatment, though there was no significant difference in
proteinuria between the two groups at the beginning of the
disease, the negative transformation rate of
proteinuria in the complete remission group was higher than that in the persistent abnormal group after 3 months (55.7% vs 34.2%, χ2=4.562, P=0.033). (3) According to International study of
Kidney Disease in
Children (ISKDC)
pathology classification, 14 cases (36.8%), 21 cases (55.3%), 3 cases (7.9%) withⅡ, Ⅲ, Ⅳ level in the persistent abnormal group and 21 cases (30.0%), 49 cases (70.0%), 0 case with Ⅱ, Ⅲ, Ⅳ level (70.0%) in the complete remission group after (20.16±24.86) months of follow-up, and the difference between the two groups was not statisticcally significant ( Z=-0.135, P=0.892). According to the Oxford
Classification of
IgA nephropathy, 36(33.3%)
children had tubule-interstitial lesions (T1, 26%-50% tubular
atrophy or interstitial
fibrosis), and the proportion in the persistent abnormal group was significantly higher than that in the complete remission group (50.0% vs 24.3%, Z=-2.695, P=0.007). (4) Compared with T0 (0-25% tubular
atrophy or interstitial
fibrosis), the
incidence of gross
hematuria and
hyperuricemia in the T1 tubule-interstitial lesion were both higher than that (respectively 63.9% vs 27.8%, χ2=13.061, P<0.001; 38.9% vs 22.2%, χ2=3.983, P=0.046). (5) Multivariate
logistic regression analysis showed that renal tubule-interstitial lesion was a
risk factor for poor
prognosis of HSPN ( OR=2.580, 95% CI 1.055-6.310, P=0.038).
Conclusions:
Renal tubule-interstitial lesion is a
risk factor for the persistent abnormal of HSPN. Gross
hematuria and
hyperuricemia are related to tubule-interstitial lesions.