The Clinlical Study On Repeated Renal Biopsy In Children With Henoch-Sch(o|")nlein Purpura Nephritis

Backgroud:Henoch-Schonlein purpura(HSP) is one of the most common small vasculitis, affecting the skin, joints, gastrointestinal tract and the kidneys. Henoch-Schonlein purpura nephritis is secondary to Henoch Schonlein purpura nephritis (HSP), and it is the chief factor affecting the prognosis of HSP patients. HSPN is a common childhood secondary glomerular disease. Analysis the renal biopsy data of the Children’s Hospital of Zhejiang University School of Medicine, Zhejiang University of recent20years, Henoch Schonlein purpura nephritis accounted for35.6%of the total number of renal biopsy (800/2245). Because of the diagnostic criteria and follow-up time difference, the kidney damage rates in patients with Henoch Schonlein purpura vary greatly, as reported in20%～100%.The main histopathological changes of HSPN are proliferation and Matrix Hyperplasia of glomerular mesangial cells. Through the appropriate treatment, most patients have favorable prognosis. But there are reports of about1%～15.7%with renal damage. About3%of Henoch Schonlein purpura nephritis may progress to end stage renal disease and need renal replacement therapy. The clinical manifestations of Henoch Schonlein purpura nephritis variety, can be divided into isolated hematuria, isolated proteinuria, hematuria and proteinuria, acute nephritis, nephrotic syndrome, and pathological type is diverse, the clinical manifestations and pathological often not parallel. Clinical manifestations can be very light, but pathology may be very serious. Therefore should observe, timely in order to understand the pathological changes of renal biopsy, pathological basis and clinical combined treatment. Renal biopsy is invasive examination, therefore, domestic has not been generally carried out in pediatrics, repeated renal biopsy to carry out less often, not easy to be parents and children, so after HSPN treatment, the pathological changes in children has not been reported. This paper studied in our hospital in recent20years with repeated renal biopsy in800cases of HSPN underwent renal biopsy in patients with Henoch Schonlein purpura nephritis patients, and to evaluate the changes before and after the treatment and prognosis of the clinical and pathological features.Purpose:To evaluate the importance of repeated renal biopsy for pathological changes, treatment guide and prognosis of the children with Henoch-Schonlein purpura nephritis.Methods:The patients were from January1995to December2014at the Children’s Hospital of Zhejiang University School of Medicine, Nephrology inpatient clinical diagnosis of Henoch-Schonlein purpura nephritis, the pathology diagnosis of Henoch-Schonlein purpura nephritis, and repeated renal biopsy after a period of a total of16cases of children. Retrospective collection, analysis of clinical and pathological data of children, and long-term follow-up, to understand their condition changes and the outcome of the situation.Results:There were16patients with HSPN undergoing repeated renal biopsy from January1995to December2014.And there were8boys and8girls. The ages were between6and15years old. The durations were from12to81months. And the follow-up periods were between2and19years. The first renal biopsy from the onset were between1and9months, and the second renal biopsy interval were from0.5years to6years. Clinical types of hematuria and proteinuria six cases, four cases of acute nephritis, nephrotic syndrome in6cases. In accordance with standards of the International Children’s pathology Society of Nephrology (ISKDC) were developed Ⅱa～Ⅵb grade level. Renal pathology of the same type in5(31.3%) patients; improvement of5patients(31.3%), deterioration of6patients(37.5%).2(12.5%) patients progressed to the sclerosing glomerulonephritis. There were three patients whose the first renal pathology were type IV b or worse, the second pathological types are identical with the previous or progress.6(37.5%) patients due to recurrent purpura, recurrent disease for repeated renal biopsy,1patient of pathology improved, two patients of the same histological type, and3patients worse.10patients(62.5%) with mild lesions or early implementation of high-dose methylprednisolone pulse therapy with cyclophosphamide the prognosis were good. The prognosis of6(37.5%) children with persistent proteinuria were poor, and two patients need end renal replacement therapy.Conclusions:The pathology of HSP nephritis is diverse, the prognosis may be related to the pathology grading. In the case of severe pathology, purpura relapse or sustained abnormal urinal analysis, the repeat renal biopsy should be taken to estimate the condition. Repeat biopsy has clinical significance in guiding further treatment.