Analaysis Of The Clinical Risk Factors For Kidney Damage To Henoch-schonlein Purpura In Children

Objective: Allergic purpura (Henoch-Schonlein purpura, HSP) is a kindof inflammation caused by a variety of causes, it’s main pathological changesis microvascular inflammatory. It often cause multiple organ damage such asthe skin, the digestive, the joints, the urinary system and other organs. Themain performance of HSP is hemorrhagic rash that ofen symmetricallydistributes in the double lower limbs without platelet decline, meanwhile withor without joint pain and inflammation, abdominal pain and gastrointestinalbleeding or hematuria, proteinuria and other symptoms of kidney damage. Itcan happen nasal bleeding, intracranial hemorrhage, bleeding gums, and eventesticular bleeding, etc. It damages different systems have the different clinicalsymptoms. Allergic purpura often occurs in school-age children, and boysmore than girls. In recent years the incidence of HSP has a tendency to riseyear by year.Kidneys are rich in capillaries, So it easily affected and cause secondaryglomerular injury, this is the so-called Henoch-Schonlein purpuranephritis(HSPN). It Is the most common pediatric secondary glomerulardisease. Kidney damage has different performance, Most of the children arewith a single hematuria and/or single proteinuria as the main symptoms, at thesame time with or without hypertension, edema, etc. The symptoms of kidneydamage usually develops in HSP course of a month, it also can occur inpurpura or other symptoms disappeared or more late. But there are a fewpatients，the symptoms of kidney damage is his first symptoms，usuallyoccurred before the rash. Whether HSPN occurs and its body damage directlyaffects the prognosis of the disease. Generally speaking, most of HSPprognosis is good, but some of the children with recurrent hematuria,albuminuria，it’s long-term prognosis is poor. About15%will be sustained damaged, And most terrible is it can progress to kidney failure, eriouslyaffected the children’s quality of life and life. Therefore, analyzing the relatedclinical risk factors for kidney damage and intervening these factors inadvance has vital significance to prevente the severe kidney damage andimprove the quality of life in children.Methods:1. The research object: from2012January to2013June in pediatric hebeimedical university second hospital income Hosptial of193patients withallergic purpura and initial treatment were as the research object. Thediagnosis of allergic purpura standards are from “huFuTang practicalpediatrics”. Meeting the following two can be diagnosed:(1). Tangibilitypurpura;(2). The onset age <20years old;(3). with acute abdominal pain;(4).Biopsy showed small veins or small artery neutrophil infiltration. Diagnosis ofPurpura nephritis: in the course of the disease on the basis of allergicpurpura in6months, appears hematuria and(or) proteinuria, meawhileexclusion of IgA nephropathy, thrombocytopenic purpura, hepatitis b virusassociated glomerulonephritis, systemic lupus erythematosus (sle) and othersystemic diseases.2. Research methods: Select193cases of children with allergic purpura,12cases were lost to follow-up and they are not included in the analysis. The181cases,according to whether having the blood in the urine or urinaryprotein, they were divided into different groups. Make statistics respectivelyof the180cases of children with gender, age, skin rash or not again and again,with or without joint pain, abdominal pain and gastrointestinal bleeding, theWBC and PLT count in peripheral blood, peripheral blood IgA, IgG，IgM, C3and C4levels, blood lipid，CRP, ESR etc.3.Statistical analysis: using SPSS Statistics13.0software for data statistics,description and statistical analysis of data. Gender,age,possible risk factors ofrenal involvement were analyzed by univariate and multivariate Logisticregression analysis. Select P<0.05for statistical significance. Results:1. General information:193cases of HSP children,111cases (57.5%) ofboy,82cases (42.5%) of girl, the boy to girl ratio is about1.35:1. In theonset age, the youngest is2years old, the biggest is14years old, the averageage is (7.8-2.54).12cases were lost to follow-up(6.21%).2. Clinical characteristics: all of the193cases of HSP children have purpurasymptoms,25cases (12.9%) of children are with Joint symptoms.127cases ofchildren are with abdominal pain (65.8%) and32cases have thegastrointestinal bleeding (16.6%).3. The single factor analysis of kidney injury risk factors: Compare of therenal injury’s enumeration data, the result shows that age≥6years old,recurrence of skin rash≥3times and the digestive tract hemorrhage in thedifferences between the two groups have statistical significance; Compare ofthe renal injury’s measurement data,the result shows that the PLT, the WBC,the TC, the HDL and LDL level differences between the two groups havestatistical significance.4. Logistic regression analysis of multiple factors of renal injury: the resultsshows that recurrence of skin rash≥3times， the digestive tract hemorrhage,the decrease of peripheral blood PLT count, the increase of serum TC levelsand the increase of serum LDL levels is the risk factors for children withallergic purpura occurs kidney damage (P <0.05).Conclusion:1.The age≥6years old, the increase of peripheral blood WBC count and theincrease of serum HDL levels may be associated with the occurrence ofallergic purpura.2. recurrence of skin rash≥3times， the digestive tract hemorrhage, thedecrease of peripheral blood PLT count, the increase of serum TC levels andthe increase of serum LDL levels is the risk factors for children with allergicpurpura occurs kidney damage. Therefore to avoid serious consequences, the children with HSP who have the risk factors should be strengthen themonitoring and should be given early aggressively treatment.