Risk Factors For Renal Involvement Analysis Of Children With IgA Vasculitis

[Objective]Henoch Schonlein purpura nephritis is one of the common secondary glomerular diseases in pediatrics,which is the key factor to determine the prognosis of IgA vasculitis.There are differences in the incidence of renal damage in children with IgAV.In order to determine the risk factors of HSPN,this study retrospectively analyzed the clinical data of 537 children with IgAV admitted to the First Affiliated Hospital of Xiamen University from June 2016 to May 2019,To explore the risk factors of renal involvement in children with IgA V,and to provide valuable reference for the early prediction and clinical diagnosis of HSPN.[Methods]A retrospective analysis of 537 cases of HSP from June 2016 to May 2019 in the First Affiliated Hospital of Xiamen University Medical records of the child.The clinicopathologic data of the children were collected by the electronic medical record system.According to the definition of renal involvement,the children with HSP were divided into the group with renal involvement and without renal involvement.The differences in clinical characteristics and laboratory parameters between the two groups were compared.SPSS 23.0 was used to compare and analyze the differences between the two groups of indicators;univariate and multivariate Cox regression equations were used to analyze the risk factors of renal involvement in children。[Results]1.General data: 537 children,311 males,226 females,213 in IgAVN group,121 males and 92 females,324 in IgAV group,190 males and 134 females,with no significant difference between the two groups(P > 0.05),6.9 ± 2.7 years old(range:1-13 years old)and 7 in IgAVN group The mean age of onset in IgAV group was 5.89± 2.48 years old,the difference between the two groups was statistically significant(P< 0.05),the BMI in IgAVN group was 16.65 ± 3.23,the BMI in IgAV group was15.91 ± 2.85,the difference between the two groups was statistically significant(P <0.05).2.Season of onset: IgAV occurs in all seasons: 107 cases in spring(March may),46 cases in IgAVN(46 / 107,42.9%);77 cases in summer(June August),29 cases in IgAVN(29 / 77,37.6%);158 cases in autumn(September November),66 cases in IgAVN(66 / 158,41.7%);195 cases in winter(December February),72 cases in IgAVN(72 / 195),36.9%),IgAV had a higher incidence rate in winter and spring,and there was no significant difference in incidence rate between the two groups(P>0.05),suggesting that there was no seasonal difference in incidence of IgAVN.3.Infection factors:(1)infection site: 23 cases(23 / 537,4.3%)with oral caries,155cases(155 / 537,28.9%)with rhinitis / sinusitis,264 cases(264 / 537,49.2%)with pulmonary infection,139 cases(139 / 537)with digestive tract infection,5 cases(5 /537,0.9%)of urinary tract infection,3 cases(3 / 537,0.5%)of other parts(such as hand,foot and mouth disease)suggested that respiratory tract and digestive tract infection were common;(2)Pathogenic Distribution: 176 cases(176 / 537,32.8%)of mycoplasma infection,131 cases(131 / 537,24.9%)of Helicobacter pylori infection,68 cases(68 / 537,12.6%)of EBV infection,83 cases(83 / 537)of Streptococcus infection,8 cases(8 / 537,1.5%)showed mycoplasma infection and Helicobacter pylori infection.There was no significant difference between IgAVN group and IgAV group(P > 0.05).4.Clinical manifestations: skin purpura: at the time of diagnosis,all the HSP children in the group had skin Pura of both lower limbs,accompanied by other parts(such as upper limbs,trunk,back of ear,face,perineum)in 158 cases(158 / 537,29.4%),IgAVN group with other parts of purpura 117 cases(117/158,68.5%),IgAV group accompanied by purpura 52(52/158,31.5%),two groups of other lower extremities with other parts of purpura incidence rate was compared,the difference was statistically significant(P < 0.05);joint symptoms: IgAV group of children with joint symptoms 287 cases,HSPN group with symptoms of 99 cases of joint(99/287,46.5%),IgAV group with 188 symptoms of 188(58%).There was no significant difference in the incidence rate of joint symptoms between the two groups(P>0.05);gastrointestinal symptoms: 277 cases of IgAV were accompanied by gastrointestinal symptoms,111 cases of IgAVN group with gastrointestinal symptoms(111/277,40.1%),and 166 cases of IgAV group with joint symptoms(166/277,59.9%).There was no significant difference in incidence rate of gastrointestinal symptoms between the two groups(P>0.05);neurovascular edema: 133 cases of IgAV group accompanied with neurovascular edema,49 cases of IgAVN group with gastrointestinal symptoms(49/133,36.8%),84 cases of NHSPN group with joint symptoms(84/133,63.2%),and no significant difference in incidence rate of neurovascular edema between the two groups(P>0.05).5.Renal involvement:213 children(213 / 537,39.7%)in IgAVN group,in this study,including 23 cases of isolated hematuria(23 / 213,11.0%),15 cases of isolated albuminuria(15 / 213,7.0%),143 cases of hematuria albuminuria(143 / 213,67.0%),4 cases of nephritis syndrome(4 / 213,2.0%),28 cases of nephrotic syndrome(28 /213,13%),the incidence rate of proteinuria in hematuria is the highest,nephritic syndrome is the second,nephritic syndrome is the lowest,among which 43 cases are renal biopsy,2 cases(I)are pathological grade,2 cases(2/43,4.6%)are grade II,23cases(23/43,53.5%)are IIIa grade,15 cases(15/43,34.9%)are IIIa grade,3 cases are IIIb grade(3/43,7.0%).6.Laboratory test: there was no significant difference in blood routine test and C-reactive protein: leukocyte count,neutrophil ratio and C-reactive protein level between the two groups(P > 0.05),platelet count in IgAVN group was 113.72 ± 6.69(× 109 / L),platelet count in IgAV group was 108.17 ± 7.81(× 109 / L)The level of serum albumin in IgAVN group was 39.54 ± 5.40,that in IgAV group was 41.13 ±3.95,and that in IgAVN group was 0.96 ± 0.20,and that in IgAV group was 0.72 ±0.18(P < 0.05)The serum creatinine level of IgAVN group was 33.83 ± 9.02,IgAV group was 30.06 ± 9.10,there was statistical difference between the two groups(P <0.05);there was no statistical difference between the two groups(P > 0.05);there was no statistical difference between the two groups in the level of D-dimer,fibrinogen and fibrinogen degradation products(P > 0.0)5)The percentage or ratio of T cell,B cell or NK cell,and the level of serum immunoglobulin A,m,G,E in the two groups were compared,only the percentage or ratio of CD3 + CD8 + T cell,CD3 + CD4 + /CD3 + CD8 + and IgG had statistical difference(P < 0.05),the rest had no significant difference(P > 0.05);The WBC count of HSPN group was 14.19 ± 29.25,which was higher than that of IgAV group.The difference between the two groups was statistically significant(P < 0.05).7.Univariate analysis of variance: the risk factors of IgAVN were more than 8 years old,BMI increased,purpura in other parts of lower limbs,Cystatin C level,serum albumin level,immunoglobulin G,platelet count,CD3 + CD4 + / CD3 + CD8 + < 1,and CD3 + CD8 + cell ratio.The difference between the two groups was statistically significant(P < 0.05).The other evaluation factors in the two groups were not statistically significant All of them(P < 0.05).8.Multivariate logistic regression analysis: the results showed that: age ≥ 8 years old:or = 2.77,95% CI: 1.45 ～ 5.32,P < 0.001;BMI: or = 1.15,95% CI: 0.983 ～ 1.362,P= 0.08;purpura in both lower limbs and other parts: or = 8.07,95% CI: 4.38 ～ 14.86,P < 0.001;cystatin C increased: or = 4362.89,95% CI: 260.62 ～ 73068.74,P < 0.001;albumin decreased: or = 9.16,95% CI: 4.42-19.00,P < 0.001 and immunoglobulin G decreased: or = 0.845,95% CI: 0.728-0.980,P = 0.026.All of the above were independent risk factors for renal involvement;there was no significant difference in aseptic leukocyturia,platelet count,CD3 + CD8 + cell ratio,and CD3 + CD4 + / CD3+ CD8 + < 1(P > 0.05).9.ROC curve: results: the ROC curve AUC of BMI was 0.579,95%(0.528,0.630),the Jordan index was 0.157,the sensitivity was 65.7% and the specificity was 50% when the threshold was 15.21,the AUC of cystatin C was 0.901,95%(0.873,0.930),the Jordan index was 0.676,the sensitivity was 86.5% and the specificity was 81.1%when the threshold concentration was 0.765g/l,the AUC of albumin and immunoglobulin G were 0.43%,respectively,0.419,no diagnostic value.[Conclusion]1.The age of IgAV children is more than 8 years old,the risk of kidney involvement is increased,and the frequency of urine test should be increased in the elderly children.2.The pathology of IgAVN mainly consists of hematuria and albuminuria,which are common in grade II and IIIA.Pay attention to monitoring the urine routine and renal function,and take renal biopsy as early as possible if they meet the conditions,so as to determine the pathological type and guide the clinical treatment.3.Respiratory tract and digestive tract infection are common in IgAV children;mycoplasma infection and Helicobacter pylori infection are common.Pay attention to pathogen screening and early treatment to reduce the risk of recurrence.4.The leukocyte of aseptic urine is increased in children with IgAVN,and the leukocyte is mainly lymphocyte,but the relationship between inflammation needs to be further proved to exclude the cell increase caused by infection.5.Age ≥ 8 years old,BMI increase,purpura in other parts,albumin decrease,Cystatin C increase and immunoglobulin G decrease are independent risk factors of renal involvement in children with Henoch Schonlein Pura.Children with the above factors need to strengthen outpatient follow-up,achieve early recognition and early intervention.6.When cystatin C is greater than 0.765g/l,it has diagnostic value for IgAVN,with sensitivity of 86.5% and specificity of 81.1%.Cystatin C can be monitored early and kidney damage can be recognized early when the above-mentioned high-risk factors exist in clinic.