Pathological Feature And Prognosis Of Henoch-schonlein Purpura Nephritis With Massive Proteinuria In Children

Objective: To discuss the pathological featue and progrosis and outcome predictors of henoch-Sch?nlein purpura nephritis(HSPN)with massive proteinuria in children.Methods: clinical and pathological data of 221 children with HSPN and massive proteinuria,who were admitted to Children's Hospital of Chongqing Medical University from January 2006 to December 2015,were collected and analysis retrospectively.The other HSPN cases who performed a renal biopsy in the same period were selected as the control group,and comparing the difference between their pathological feature.And the follow-up data of 111 children who had massive proteinuria were studied.Results:(1)Among all the HSPN patients who performed a renal biopsy in the same period,the percentage of 221 cases with massive proteinuria is 52.1%.According to the international study of kidney disease in children,the majority renal pathology type of HSPN with massive proteinuria is grade ?(68.3%),followed by grade ? 61case(27.6%),then above grade ? 7case(3.2%),only 2 case are grade ?.Its pathological grade,crescent,capillary change and necrosis were all severer than non-massive proteinuria HSPN(P < 0.05).(2)Among the 111 children,whose median duration of follow-up was 4.2±2.7 years,63 cases(56.8%)had good outcomes(grade A),41 cases(36.9%)had grade B,4 cases(3.6%)had grade C,only 3(2.7%)progressed to ranal failure.(3)In univariate analysis,girls were more dangerous progressed to severe prognosis(P=0.048),the higher proteinuria and serum creatinine(Scr)the worser outcome(P=0.019,P=0.015),the IgA deposition grade was related with prognosis(P=0.046).(4)The prognosis of children,whose pathological findings were grade ? and above,47 cases(56.0%)belonged to grade A,31 cases(36.9%)were in grade B,4 cases(4.8%)were in grade C,and 2 cases progressed to grade D.There was no significant effect between pathological stage and prognosis(P > 0.05).(5)Among the 111 patients,who had follow-up data,7 cases had relapse of proteinuria,including 3 cases with rash,and the relapse time was 1.5-5.3years.The prognosis of children belonged to grade A in 1 case,who had proteinuria relapse,3 cases belonging to grade B,3 cases in grade C.Proteinuria relapse was obvious correlation with prognosis(P=0.003).(6)Multivariate logistic regression revealed that girls and relapse of proteinuria are predictors of prognosis in massive proteinuria HSPN(P<0.05).Conclusion: The most common pathological stage of massive proteinuria HSPN is grade ?,and its pathological injury are severer than non-massive proteinuria.After early and normative treatment,the prognosis of HSPN with massive proteinuria is good.Our results suggest that girls and relapse of proteinuria are predictors of prognosis in children with HSPN presenting with massive proteinuria.Because some children had proteinuria relapse,HSPN need 5 years long-term follow-up at least.