Correlation Between Clinical Indicators And Renal Pathology In Children With Henoch-Sch(?)Nlein Purpura Nephritis

Objective: Henoch-Sch(?)nlein purpura nephritis(HSPN)is a common type of secondary glomerulonephritis in childhood.The renal pathological manifestations of HSPN are not only the gold standard for diagnosis,but also can guide clinical treatment and predict the prognosis of HSPN.The aim of our study was to analyze the relationship between common clinical indicators and renal pathology in children with HSPN and to explore clinical markers that could predict the grades of renal pathology.Methods: The clinical and pathological data of 69 children with HSPN who were admitted to the First Affiliated Hospital of Anhui Medical University from January 2017 to December 2021 and confirmed by renal biopsy were retrospectively analyzed.Whether there were differences in clinical indicators among different renal pathological grades was evaluated.Results:(1)The renal pathological grades of 69 HSPN children included grade Ⅱ in 30 cases(43.5%),grade Ⅲa in 12 cases(17.4%),grade Ⅲb in 27 cases(39.1%),and no grade I,IV,V,or VI.(2)Clinical types included 14 cases(20.3%)of isolated proteinuria,46 cases(66.7%)of hematuria and proteinuria,and 9 cases(13.0%)of nephrotic syndrome,which differed among the renal pathological grades(P<0.05).Renal pathology in children with nephrotic syndrome was predominantly evaluated as grade Ⅲb.(3)Serum albumin,24 hour urine protein(24h-UP),urine albumin,and urine immunoglobulin G levels were statistically different among renal pathological grades(P<0.05).There was no statistical difference between grade II and grade Ⅲa,grade Ⅲa and grade Ⅲb,and only a statistical difference between grade II and grade Ⅲb.(4)Children with grade Ⅲb mostly exhibited nephrotic range proteinuria,with urine albumin as the main component.Urine albumin(r = 0.317,P = 0.010)and urine immunoglobulin G(r = 0.351,P = 0.004)levels were positively associated with renal pathological grades.(5)Elevated 24h-UP levels were positively correlated with renal pathological grades(r=0.308,P=0.011),and its area under the receiver operating characteristic curve for predicting grade IIIb was 0.702.When 24h-UP > 24.79 mg/kg,the sensitivity and specificity of prediction were 61.5% and 81.0%,respectively.Conclusions: The levels of urine protein in children with HSPN were closely related to the types of renal pathology.When 24h-UP > 24.79 mg/kg,the degree of renal lesion might be severe,and clinicians could refer to this criterion to initially predict the renal pathological grades of children with HSPN.