| ObjectiveThis study aims to analyze the clinical data of 616 children with Henoch-Schonlein purpura nephritis(HSPN)admitted to Shandong Provincial Hospital affiliated to Shandong University during the past 10 years.The clinical manifestations,renal pathological features,long-term prognosis and relapse of HSPN were summarized.Comparing the differences among HSPN in children with different degrees of proteinuria,in order to provide a valuable reference for clinical work in the region.Methods616 children with HSPN in Shandong Provincial Hospital from July 1,2007 to June 30,2017 were retrospectively reviewed.The clinical and pathological data of these children were collected through the electronic medical records system,and the longterm follow-up data and prognosis of the children were collected and entered into the EXCEL database.According to the urine routine and 24-hour urinary protein level results of children,the children were divided into no proteinuria group(NP group:only urine red blood cell count ≥ 3HP),mild proteinuria group(MIP group:only urinary microalbumin increased,and/or 24-hour urinary protein ≥ 0.15g/24h and<25mg/kg,or with hematuria),moderate proteinuria group(MOP group:25mg/kg ≤24 hours urinary protein level<50 mg/kg,or with hematuria)and severe proteinuria group(SP group:24-hour urinary protein ≥ 50 mg/kg,or with hematuria).The clinical pathological features and long-term prognosis were compared by SPSS22.0.Results1.There were 616 children with HSPN,including 377boys and 239 girls.The ratio of boys and girls was 1.58:1.The onset age was 2 to 15 years and the mean age was 8.07±2.53 years.The onset age and sex in these four groups exhibited no statistically significant differences.2.Clinical classification:The average time from HSP to abnormal urine is 14.6 days.Hematuria and proteinuria were the most common,with 480 cases accounting for 77.92%,followed by nephrotic syndrome(69 cases,11.20%),isolated hematuria(38 cases,6.17%).Isolated proteinuria HSPN(28 cases,4.55%)and chronic nephritis(1 case,0.16%).3.Coagulation parameters:Platelet(PLT),D-dimer,prothrombin time(PT),activated partial prothrombin time(APTT),thrombin time(TT),fiber(FIB)were compared in four groups,the PT and APTT exhibited statistically significant differences,and there was no significant difference in the other coagulation parameters.PT and APTT in SP group were significantly shorter than those in other three groups.4.Renal function parameters:4 groups were compared with blood urea nitrogen(BUN),serum creatinine(Scr),cystatin C(Cys-C)and uric acid(UA).The difference of Cys-C was statistically significant,and other renal function parameters exhibited no statistically significant differences.MOP group and SP group had significantly higher Cys-C level than the other two groups.5.immune parameters:4 groups were compared for IgA,IgQ IgM,IgE,CD3+,CD3+CD4+,CD3+CD8+,CD16+CD56+,CD19+,4/8Ratio,C3 and C4.Among them,IgG,IgA,C4,CD 16+56+ and CD 19+ had statistically significant differences.The differences of other immune parameters were not statistically significant.IgG,IgA,C4,and CD 16+56+ in the SP group were significantly lower than other three groups.CD 19+ was significantly higher than the rest three groups.6.ISKDC grade:A total of 146 patients underwent renal biopsy,of whom no renal biopsy was performed in the IH group;12 patients had grade I(8.22%),13 wereⅡa(8.90%),and 17 were Ⅱb(11.64%),grade Ⅲa was found in 40 cases(27.40%),grade Ⅲb in 63 cases(43.15%),Va grade in 1 case(0.68%),the grade Ⅲb was the most.Except for grade Va in SP group,the remaining pathological grades were distributed in all three groups.Compared with the three groups,the pathological grading exhibited statistically significant differences.The renal pathological tissue damage were more severe in the MOP group and the SP group,and the proportion of the Ⅲb was higher.The renal pathological tissue damage in the MIP group were lighter.The proportion of the I was higher than that of the MOP group and the NP group.There was no statistical difference in the remaining pathological grades.7.Immune complex deposition:The most common immune complexes were IgA+IgM(50 cases,36.77%),followed by IgA(42 cases,30.88%),IgA+IgG+IgM(30 cases,22.06%),and IgA + IgG(14 cases,10.29%),there were 4 cases without IgA deposition;55%of the children had immune deposits associated with C3 deposition,the rest of the patients did not have C3 deposition,In the three groups,there was no statistical significance difference in the type of immune complexes and the presence or absence of C3 deposition.8.Prognosis:All patients had a follow-up of six months to ten years,93 cases were lost,the rate of loss to follow-up was 15.10%,457 cases(87.38%)had a good outcome,64 cases still had mild urinary anomalies(12.24%),and 1 case still had a nephrotic proteinuria(0.19%),1 case had an end-stage renal disease(ESRD)(0.19%).Compared with the four groups,the prognosis was statistically different.The proportion of complete remission in the SP group was less,the proportion of mild urinary anomalies was more,and there were serious cases in the SP group,and the prognosis was worse than the other three groups.9.Relaps:A total of 9 patients had relaps with a rate of 1.72%,8 patients in the SP group(88.89%)and 1 patient in the MIP group(11.11%);after relapse,there were 7 patients whose proteinuria level was lower than the first time(77.78%),only 1 patient’s proteinuria level was higher(11.11%),proteinuria was unchanged in 1 patient(11.11%)compared to the time of first onset,and among the 9 patients in the SP group,there were 3 cases had complete remission(Grade A),4 cases of mild urinary anomalies(Grade B),1 case lost to follow-up.One relapsed child in the MIP group was currently completely relieved(Grade A).Conclusion1.HSPN in the center was mainly hematuria and proteinuria,and the aveiage time from HSP to urinary anomaly was 14.6 days.2.The more severe the degree of proteinuria in children with HSPN,the more severe the hypercoagulable state,immune dysfunction and kidney damage.PT,APTT,Cys-C,IgG,IgA,C4,CD 16+56+,CD 19+ may be used to predict the severity of HSPN,and provide early evidence for the prognosis and treatment of HSPN in children.3.The more severe the degree of proteinuria in children with HSPN,the more severe the renal pathological damage,but there are a small number of HSPN who had been delayed for a longer period with mild proteinuria,there will be a serious pathological grading,and it is necessary to be a timely biopsy of the kidney to determine the degree of pathological damage and guide treatment.4.The immune complex deposition type of the children with HSPN in our center is mainly IgA+IgM deposition.5.The overall prognosis of children with HSPN is good,and the relaps rate is low,but children HSPN with nephrotic proteinuria are more likely to have severe cases and poor prognosis.The follow-up of children’s HSPN should be performed for a long time. 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