Clinicopathological Features And Prognosis Of Henoch-Sch(?)nlein Purpura Nephritis In Children

BackgroundHenoch-Sch(?)nlein purpura is a systemic necrotizing vasculitis as the main pathological changes of the disease,with skin purpura as the main clinical features,with abdominal pain,hemafecia,joint pain,and even can be accumulated in other organs,including injury involving the kidney called Purpura nephritis(Henoch-Sch(?)nlein Purpura nephritis,HSPN).This disease is common in children and adolescents and is one of the most common secondary nephropathy in childhood.Foreign literatures reported that the incidence of HSP renal involvement was 20% to 80%.Among them,HSPN 1.0%-15.7% developed to end-stage renal failure,affecting children's life and health,so it needs to be taken seriously.ObjectiveTo investigate the clinicopathological features and treatment outcome of HSPN in children.MethodsRetrospective analysis was performed on data on clinical pathology and treatment outcome of 83 pediatric patients undergoing renal biopsy in the hospital.ResultsThe ratio of male to female in 83 children with HSPN was 2.3: 1,the onset age was 4 years to 16 years,the average age(9.3 ± 3.3),the course of the disease was 1 d to 12 years.The data of this study showed that the incidence of HSP occurred in 7-12 years,there were 57 cases of HSPN in 4 weeks(68.7%)and 76 cases(91.6%)of HSPN in 6 months.The most common clinical types were hematuria and proteinuria types,accounting for 68.7%(57/83)of the patients,followed by nephrotic syndrome type,accounting for 18.1%(15/83)of the patients;isolated hematuria,isolated proteinuria and acute nephritis types were rare.The tubular pathological grade was predominantly grade II,accounting for 53.0%(44/83)of the patients,following by grade?,accounting for 32.5%(27/83)of the patients;In 1 case,the clinical classification was light and the pathological classification was grade III,in 7 cases,the clinical classification was grade I and II.There was some correlation between the severity of clinical classification and the degree of pathological classification(r=0.415,P<0.05).The heavier clinical classification,the heavier the pathological classification,but some of them were not completely parallel.the tubulo-interstitial pathological grade was predominantly grade +,accounting for 42.2%(35/83)of the patients,following by grade ++,accounting for 25.3%(21/83)of the patients;immune complex deposition was predominantly simple IgA deposition(40/83).There was a positive correlation between the severity of clinical type and the pathological grade(r=0.415,P<0.05),with more severe clinical type associated with higher pathological grade.There was correlation between the tubulo-interstitial pathological grade and the pathological grade(r=0.543,P<0.05),with the pathological grade increasing with the tubulo-interstitial grade.There was correlation between the type of immunocomplex deposition and pathological classification(r=0.429,P<0.05;r=0.680,P<0.05),the more severe the pathological classification,the more obvious the deposition of the immune complex.83 cases of HSPN were completely relieved by 47 cases(56.6%)and some of them were alleviated in 35 cases(42.2%),and the effective rate of treatment was 98.8%.The correlation between different pathological grades and prognosis was correlated(r=0.548,P < 0.05),and the higher the pathology grade,the worse the prognosis.The degree of renal tubular-interstitial lesions was significantly correlated with the prognosis(r=0.533,P < 0.05),and the prognosis was poor with the aggravation of renal tubule-interstitial lesions.Conclusion1.Most HSP children develop renal damage within 6 months,and should be followed up for at least 6 months to to detect renal damage early.2.There is a certain correlation between the clinical symptoms of HSPN and pathological lesion,but there is a partial inconsistency,and the renal tissue biopsy should be conducted in a timely manner to make sure the extent of renal damage.3.According to the clinical classification and pathological grading of children with HSPN,the clinic should develop individualized treatment plan and extend the follow-up time,so as to reduce the development of renal damage and improve the prognosis of children.