Prognosis Of Henoch-schonlein Purpura Nephritis In Children With Massive Proteinuria Analysis Of Adverse Risk Factors

Objective To explore the risk factors of prognosis of children with Henoch-Schonlein purpura nephritis(HSPN)accompanied by massive proteinuria,in order to provide clinical theoretical basis for formulating appropriate treatment programs for children with HSPN.Methods The clinical data of hospitalized HSPN patients with massive proteinuria were collected from May 1,2012 to August 31,2018 in the First Affiliated Hospital of Guangxi Medical University.The patients were grouped according to the treatment effect after 6 months.The general data,clinical manifestations,laboratory indicators,pathological types and prognosis were retrospectively analyzed.SPSS22.0 software was used for all data processing.Rank sum test was used for comparison of non-normal distribution measurement data and ordered data.The description of counting data was expressed by percentage and quartile spacing.Fisher’s exact probability method was used for inter-group comparison.Fifty-three children were divided into two groups according to the 6-month curative effect: group I: good prognosis(36 cases);group II: poor prognosis(17 cases).The general data,clinical manifestations,laboratory indicators and pathological types of the two groups were compared.Results 1.A total of 58 HSPN cases with massive proteinuria were collected.5 cases were given adequate prednisone alone and 53 cases were given adequate prednisone plus immunosuppressive agents.2.There were 35males(35/53)and 18 females(18/53).Male: female = 1.94:1.The onset age ranged from 4 to 14 years,with an average age of(8.57 + 2.90)years.The course of the disease ranged from 15 days to January,and the median course of the disease was 56 days.3.53 cases of HSPN with immunosuppressive agents,28 cases had definite predisposing factors before onset,mainly respiratory tract infection(22/28).There were 29 cases with renal insufficiency at onset and 24 cases with nephrotic syndrome.The incidence of respiratory tract infection,renal function damage and nephrotic syndrome in group II was higher than that in group I(P < 0.05).4.25 cases were examined by renal biopsy.The pathological grading was ISKDC grade III,followed by ISKDC grade II.The pathological grade of group II was higher than that of group I(P < 0.05);the more severe the pathological grade,the worse the prognosis.5.The effective rate of CTX was 73.68% in 38 children treated with adequate prednisone plus cyclophosphamide(CTX).The effective rate of MMF was 53.33% in 15 children treated with adequate prednisone plus mycophenolate mofetil(MMF).The total effective rate was 67.92%.There was no significant difference between the two immunosuppressive agents(P > 0.05).6.In group I,2 children had recurrence of urinary protein after CTX treatment,and TAC was effective in all cases.In group II,1 child died,3 children were treated with tacrolimus(TAC)instead of CTX,and 1 child was treated with cyclosporine A(CsA)instead of MMF.The prognosis was good(grade A in 3 cases and grade B in 1 case).7.Multivariate analysis: repeated infection or low albumin were risk factors for poor prognosis(P < 0.05).Conclusion 1.The pathological grade of HSPN with massive proteinuria is mainly grade III.The more severe the pathological grade,the worse the prognosis.Kidney pathological examination should be carried out as far as possible to clarify the pathological type and formulate the treatment plan according to the pathological type.2.If the treatment of refractory HSPN is ineffective by CTX or MMF,TAC or CsA may be used instead.3.Repeated infection or low albumin may indicate poor prognosis of HSPN.