Risk Factors Associated With Renal Involvement In 13755 Cases Of Childhood Henoch-sch?nlein Purpura:a Systematic Review And Meta-analysis

Objective Henoch-Sch?nlein purpura(HSP)is an important cause of chronic kidney disease in children.This meta-analysis identified risk factors associated with renal involvement in childhood HSP.Method Pub Med,Embase,Web of Science,Sinomed,VIP,CNKI,and Wangfang database were searched.The quality of all eligible studies was assessed using the Newcastle-Ottawa scale criteria.An analysis of possible risk factors was conducted to report the odds ratio(OR)and weighted mean difference(WMD).Meanwhile,classifying the risk factors according to the criteria of outcome.Results Fifty-nine studies(13755 children)revealed 34 risk factors associated with renal involvement in HSP.Nine significant risk factors with the following meta-analysis estimates of OR and WMD,with 95% confidence intervals: Older age(1.21,1.09-1.34),> 10 year old(2.25,1.41-3.59),abdominal pain(1.49,1.22-1.82),severe bowel angina(3.68,1.91-7.10),gastrointestinal bleeding(2.23,1.85-2.68),persistent purpura(2.92,1.81-4.71),relapse(3.75,3.07-4.57),PTT > 300×109/L(1.62,1.32-1.99),elevated IgM(1.96,1.30-2.96);Nice possible risk factors: Rural area(1.65,1.03-2.64),boy(1.40,1.06-1.86),WBC>100×109/L(1.30,1.13-1.50),low albumin(2.62,-4.44,-0.81),elevated cholesterol(0.79,0.64-0.94),elevated fibrin(2.28,1.53-3.38),elevated urinary albumin(10.66,1.65-68.90),low C3(1.74,1.11-2.72),elevated IgE(1.66,1.01-2.73),city membership may be a protective factor(0.47,0.29-0.77).Factors not significantly associated with renal involvement were: Infections,food allergy,season,girl,arthritis/arthralgia,blood pressure,orchitis,vascular edema,elevated CRP,elevated ESR and elevated serum IgA/IgG.Conclusion The following are associated with renal involvement in pediatric HSP: Older age,exceed 10 year old,abdominal pain,severe bowel angina,gastrointestinal bleeding,persistent purpura,relapse,PTT >300×109/L,elevated IgM.Relevant clinical interventions for these risk factors may exert positive effects on the prevention of kidney disease during the early stages of HSP.However,the results should be interpreted cautiously due to the limitations of the studies.