Relationship Between Urine Protein Quantitation And Renal Pathology In Children With Henoch-schonlein Purpura Nephritis

Objective:24-hour urine protein quantitation and renal pathological features ofHenoch-Schonlein purpura nephritis in children were statistically analyzed by usingretrospective analysis method.Our study was to dinvestigate the relationshipbetween the two and provide theoretical basis for clinical diagnosis and treatment.Methods:92cases of HSPN patients hospitalized were selected as the research object inthe pediatric nephrology of the first hospital of Bethune jilin university fromSeptember2009to June2013。24-hour urine protein quantitation should be submittedfor routine laboratory analysis,and renal biopsy were carried out within1~2weeks(The renal pathologic examination included the light microscope andimmunofluorescence detection）.With the application of modern statistical methods，to carry on statistics analysis to its urinary protein quantity level、renal pathology,etc。Results:（1）The sex ratio for the92cases of children was1.49:1,and children underthe age of ten accounted for57cases(62.0%).No significant difference between agesegment and renal pathology classification existed(P＞0.05).Children began in Winterand spring were32cases、27cases (64.1%),summer and autumn were13cases、20cases.43.5%of the patients began after respiratory infections,9.8%of children witheating seafood,beef history,46.7%of children with no obvious cause.The number ofchildren whose renal damage occurs after rash appears within4weeks of was75cases (81.5%).（2）Of all the92patients,normal urine protein was7cases (7.6%),mildproteinuria with27cases (29.3%), moderate and severe group were26cases,32cases(28.3%,34.8%).Clinical type of simple hematuria or proteinuria had three cases(3.3%),hematuria and proteinuria in55cases (59.8%),nephrotic syndrome in32cases(34.8%),with2cases of acute nephritis (2.2%),and there was no type of rapidly progressive glomerulonephritis,and chronic nephritis.The type of hematuria andproteinuria are common,and nephrotic syndrome took second place.In severeproteinuria group followed by32cases,there was84.4%of nephrotic syndrome,acuteglomerulonephritis type was2patients (6.25%).（3）The majority of pathological changes of HSPN were above grade Ⅲ with60cases(65.2%).According to renal tubular interstitial pathological classificationstandard set by Bohle A,Class+accounted for87.0%,class++for13.0%.Sedimentarypattern of IgA+IgG+IgM had largest proportion (30.4%),and there was one case ofnon-immune complex deposition.（4）The group with normal urinary protein had kidney damage.Renalpathological damage is lighter,mainly below Ⅱ class.The comparison betweenmild,moderate and severe proteinuria group and the normal group was statisticallysignificant respectively.The tubulointerstitial pathological changes were moreminimal with histopathological grading+in normal group.Tubulointerstitialpathological grade level are+~++in mild,moderate and severe proteinuriagroups.But the difference between proteinuria and renal interstitial pathological gradewas not significant (P=0.100).Deposition type of IgA+IgG+IgM accounted forrespectively37%,37.5%in mild and severe proteinuria group.There was mainly IgAdeposition type in26cases of moderate proteinuria group and seven cases of normalurinary protein group (34.6%,42.9%). There was no statistically significant differencebetween albuminuria group and andimmune deposits classification (P=0.071).（5）There was a positive correlation between immune complex deposition andhistological grade (p=0.005).IgA+IgG+IgM deposition group had heavy pathologicalgrade than pure IgA,IgA+IgM or IgA+IgG group,and the difference was statisticallysignificant (P=0.015).But there was no difference between pure IgA,IgA+IgM orIgA+IgG deposition group and renal pathology classification (x2=7.39, P=0.116).Andit reminder us that the heavier the more immune complex deposition,the more seriouspathological grading.C3deposition and renal pathology grading was positivelycorrelated (P<0.05).The group that pathological grade Ⅱ,grade Ⅲ were morecommon were with increasingly C3deposition,and it was statistically significant(P<0.05).C3deposition of histological grade Ⅲ+Ⅳ group compared with grade Ⅱwas more, but there was no difference(P>0.05). Conclusion:（1）The kidney pathological changes of children with abnormal24-hour urineprotein quantitative is heavier than those normal.And it remind us that albuminuria isone of the factors that affect HSPN renal pathology。（2）The renal pathological damage was not in parallel with the level of24-hour urinary protein quantity in HSPN children。（3）The more types of immune complex deposition,the heavier renalpathological damage。And so are children with C3deposits.