Comparative Analysis Of Clinical And Pathological Features Of 113 Cases Of Henoch-schonlein Purpura Nephritis

Background and objective:Henoch-Schonlein purpura(HSP)is a kind of small vasculitis inflammatory disease which can cause a large variety of symptoms in different organs.When IgA is deposited in the glomerular mesangium and causes a series of symptoms associated with renal dysfunction,it is called Henoch-Schonlein purpura nephritis(HSPN).The degree of renal involvement is usually associated with prognosis.The statistical analysis of the pathotyping data of more than 6,000 renal biopsies conducted between 1993 and 2015 showed that of all the 930 cases diagnosed as secondary glomerular disease(SGD),HSPN is the most commom type,accounting for about 52.04% of SGD,significantly higher than the relevant reports at home and abroad.In this research our aim is 1.To compare the clinico-pathologic differences of HSPN between adult and pediatric patients.2.To find non-invasive laboratory indicators related to renal pathological changes by exploring correlation between clinical manifestations and pathological lesions of HSPN.Methods:1.Collect the clinical and pathological data of 113 patients diagnosed as HSPN by renal biopsy from January 2010 to June 2016 in The Second Hospital of Shanxi Medical University.2.Divide all the 113 cases of HSPN into two groups by age: children group and adult group,and compare the differences in epidemiological characteristics(prevalence of age,season,sex ratio,incentives,duration),clinical manifestations(rashes,joints,gastrointestinal symptoms,history of hypertension,clinical type,short-term efficacy evaluation),laboratory parameters(creatinine,urea nitrogen,24-hour urinary protein quantification,serum albumin,estimated glomerular filtration rate,)and pathological manifestations(degree of mesangial proliferation,crescent component,glomerulosclerosis,tube atrophy area,arteriole thickening,ISKDC pathological type,immunophenotypic difference)between the two groups.3.Retrospectively analysis the correlation between pathological type and clinical manifestations(age,duration,symptoms,clinical classification),laboratory parameters(24 hours urine protein quantification,serum albumin,glomerular filtration rate Estimated number,number of urine red blood cells)immunofluorescence(immunotyping,IgA deposition intensity,presence or absence of C3 deposition)of 113 patients diagnosed as HSPN;analysis the correlation between pathological acute active lesions /chronic lesions and laboratory parameters(24 hour urinary protein quantitation,serum albumin,estimated glomerular filtration rate,serum creatinine).4.Use SPSS13.0 statistical software to analyze the data,count data were compared by using non-parametric test,measurement data were compared by using independent sample t-test,P<0.05 considered as statistically significant.Results:1.In the adult group(>18 years old),there were 89 HSPN patients,and in the children group(≤18 years)were 24 patients;male-to-female composition ratio in the adult group was 1:1.2;in the children group was 1:0.4;the gender difference was statistically significant between the two groups.(P=0.04).There was a history of typical skin purpura in both groups.There was no statistically significant difference in joint and gastrointestinal symptoms,and hypertension.2.The clinical type in adult group was mainly Hematuria and proteinuria(type Ⅲ),while in the children group was predominantly Nephrotic syndrome(type Ⅳ).But therewas no significant difference in the clinical type between the two groups.Comparison of laboratory indicators: Urinary protein(P=0.012)and hypoalbuminemia(P=0.001)were more severe in children than in adults;the estimated glomerular filtration rate in the adult group was significantly lower than in children(P=0.000).There was no significant difference in serum creatinine and urea nitrogen levels between the two groups.The pathological type of adult group mainly type Ⅲ(minor glomerular abnormalities or mesangial proliferation with crescentic/segmental lesions in less than 50% of glomeruli),the children group were type Ⅲ and Ⅱ(pure mesangial proliferation),The difference of pathological type between the two groups was no significance.There were mainly IgA + IgG + IgM types in immunophenotype of both adult group and children group,there was no statistically significant difference between them.3.A significant correlation was noted between pathological type and 24-hour urine protein(P=0.030),serum albumin(P=0.019),and glomerular filtration rate(P=0.002),clinical type(P=0.003)in 113 patients with Henoch-Schonlein purpura nephritis.Acute renal lesions in 113 patients with Henoch-Schonlein purpura nephritis were associated with serum albumin(P=0.01)and 24-hour urinary protein quantification(P=0.019);chronic renal lesions were associated with age(P=0.029),serum creatinine(P=0.005),Glomerular filtration rate(P=0.012)related.Conclusion:1.The degree of renal disfunction and kidney chronic lesions are more severe in adults than in children;there is no significant difference in extra-renal manifestations, clinical types,pathological types,fluorescence types,and short-term clinical efficacy.2.The renal pathological type is related to 24-hour urine protein,glomerular filtration rate,and clinical classification.3.Kidney acute active lesions are associated with 24-hour urine protein and serum albumin.Chronic lesions are associated with age,serum creatinine,and glomerularfiltration rate.