Association Of Serum Uric Acid Level With Clinical Manifestations And Pathological Classification Of Kidney In Children With Henoch Schonlein Purpura Nephritis With Nephrotic Syndrom

Background: Hnoch-Schonlein purpura(HSP)is a small vasculitis with IgA deposition that can be involved in the whole body,which can lead to purpura nephritis(HSPN)when damage accumulates the kidney[1,2].As a secondary kidney disease in children,HSPN is more common in clinic,mainly manifested as hematuria,proteinuria,edema,renal insufficiency,and so on.The clinical classification of HSPN can be divided into isolated hematuria or proteinuria,hematuria and proteinuria,acute nephritis?RPGN?chronic nephritis,nephrotic syndrome.The main manifestations of nephrotic syndrome are large proteinuria,hypoproteinemia,edema,hypercholesterolemia,among which a large amount of proteinuria is a sufficient condition.Chronic renal damage can also be caused by persistent nephrotic levels of proteinuria(24 hours urinary protein over or equal to 50mg/kg)[3,4].and sometimes the clinical manifestations are not consistent with pathological changes.Most of the children with HSPN have a good prognosis.However,there are still some children with chronic progression,or even end stage nephropathy,which requires continuous renal replacement therapy [5,6].Therefore,the degree of pathological changes may have a great impact on the prognosis of HSPN.It is significant to select renal biopsy for HSPN(urinary protein excretion ?50mg/kg.d)in children with nephrotic syndrome.Because the end product of human purine metabolism is uric acid,so if When purine metabolic disorders occur,the incidence of hyperuricemia increases significantly,and there is a close relationship between chronic kidney disease and uric acid,as reported in the literature [7,8],in 13 recent epidemiological studies,Eight of them confirmed a close relationship between serum uric acid levels and progression of nephropathy.Therefore,children with nephrotic syndrome type HSPN were selected as the object of this study.The renal clinical indexes and ISKD pathological types of HSPN patients with different levels of serum uric acid were compared in order to find out the relationship between hyperuricemia and purpura nephritis.In addition,pathological grading of renal tubules was performed in accordance with the evidence-based guidelines for purpura nephritis in 2016.Objective: Objective to investigate the association of serum uric acid level with clinical manifestations and ISKD pathological classification of kidney in children with Henoch Schonlein purpura nephritis with nephrotic syndrome.Methods: From January 2016 to October 2017,52 cases of HSPN with nephrotic syndrome were analyzed retrospectively.According to the level of serum uric acid in children were divided into hyperuricemia group and normal uric acid group were 31 cases and 21 cases.Age,sex,blood pressure were monitored,albumin,serum creatinine,blood urea nitrogen and cholesterol were measured.24 h urine protein quantitative analysis was carried out after 24 h urine collection,and immunoglobulin G(IgG),urine ?1 microglobulin(?1-MG),urinary?2 microglobulin(?2-MG)and urinary microalbumin(U-MA)were detected.The deposition of immune complex(IgG,IgM,IgA,C3,C1 q,Fg)in capillary loop,Mesangial region and capillary loop + Mesangial region(IgG,IgM,IgA,C3,C1 q,Fg)was observed under light microscope by fixed,embedded,dehydrated,stained,and so on.Pathological classification was made according to ISKD.Compared two groups of patients with clinical indicators and the ISKD classification,association of hyperuricemia and kidney research the clinical and pathological type in ISKD.Result: The proportion of hypertensive patients with elevated uric acid was significantly higher than that of normal uric acid group(P<0.05).Serum creatinine,albumin,24 h urinary protein,blood urea nitrogen and cholesterol in patients with elevated uric acid were higher than those in normal uric acid group(P<0.05).The levels of?2-MG,U-MA and IgG in patients with elevated uric acid were higher than those in normal uric acid group(P<0.05).No significant difference was found between mesangial cell hyperplasia and endothelial cell hyperplasia in uric acid group and uric acid group(P>0.05).In the segment of glomerulosclerosis/adhesions,the proportion of S1 in patients with elevated uric acid was higher normal uric acid group(P<0.05).Tubular atrophy or interstitial fibrosis,uric acid increased in patients with T1,T2 ratio was significantly increased compared with normal uric acid group(P<0.05),the difference between the two is of statistical significance.Conclusion: Merge increased uric acid nephropathy syndrome sexual purpura nephritis than normal uric acid group in blood pressure,cholesterol,urea nitrogen,creatinine,more severe renal tubular function,blood uric acid is associated with area of HSPN immune complex deposition and sediment,and has nothing to do with the intensity of deposition,increased uric acid is nephrotic syndrome type independent risk factors in children with purpura nephritis.