Analysis Of Clinical Risk Factors Of Renal Injury In Children With Henoch-Schonlein Purpura

OBJECTIVE : Henoch-schonlein purpura(HSP),a kind of small vasculitis mediated by immune complex,is more common in children.It can involve multiple systems of the whole body,and the common ones are skin,digestive tract,joints and kidneys.The main clinical manifestations are bilateral lower limbs,buttock symmetry and non-thrombocytopenic rash,accompanied or not accompanied by joint symptoms(swelling,inflammation),abdominal pain or combined with gastrointestinal bleeding,hematuria,proteinuria,etc.HSP mostly occurs in boys,The age of onset was mainly school-age children,and the incidence of HSP has been increasing year by year in recent years.The renal damage caused by the development of HSP is called Henoch-Schonlein purpura nephritis(HSPN),The kidney is rich in capillaries,and the kidney damage is the most serious in the viscera involved in allergic purpura.Most children with HSPN showed transient microscopic hematuria and/or a small amount of proteinuria in the urine routine,and could achieve satisfactory efficacy through clinical timely and symptomatic treatment,but about 1%-7% of children with HSPN eventually developed end-stage nephropathy.but,in some cases,the early onset of the disease was hidden,and no positive indicators were found in laboratory tests.renal biopsy was difficult to be accepted by family members due to its risks and trauma,and was not widely used clinically,leading to the delayed progress of the disease and the eventual development of end-stage renal disease.Therefore,it is of great significance to analyze the clinical risk factors of renal injury in children with HSP,to intervene the occurrence and development of HSPN early,and to improve the prognosis of children with HSPN.METHODS : A total of 188 children with primary HSP who were admitted to the department of pediatrics of huaihe hospital of henan university from October 2017 to June 2019,all of whom met the inclusion criteria,were followed up for 6 months.During the follow-up,5 children were lost to follow-up and were not included in the study.Children were divided into renal injury group and non-renal injury group according to whether the children had renal injury or not.Collected include: gender,age,whether with repeated respiratory infection,skin rashes number greater than or equal to three times,the duration ofthe rash,whether to have abdominal pain,joint swelling pain,and gastrointestinal bleeding,c-reactive protein in the peripheral venous blood,blood sedimentation,white blood cell count,platelet count,immunoglobulin Ig A,Ig G,Ig M,C3 and C4 level,related urinalysis(routine urine,24 hours urinary protein quantitative),Spss22.0 software was used for statistical analysis of the above research factors.First,univariate analysis was conducted for each risk factor according to the corresponding statistical methods,and variables with statistical significance between groups were screened out,which were then included in the Logistic regression analysis model for further multi-factor analysis.The difference was statistically significant at P<0.05.RESULTS:1.General situation: In this study,a total of 188 children with primary HSP were included.the male114 cases(60.6%),female,74 cases(39.4%),the sex ratio of 1.54,1.0,The youngest child was 2.6 years old and the oldest was 14 years old,with an average age of onset(7.79±2.74)years,there are 5 cases lost to follow-up,complete follow-up for 183 cases of children,lost to follow-up rate was 2.66%.Among the 183 children included in the study,63 had renal injury,43 were male(68.3%)and 20 were female(31.7%),with an incidence of 34.4%.2.Clinical symptoms and characteristics: In 183 children with HSP,all showed signs of dermal purpura(100%);There were 28 patients(15.3%)with abdominal pain.The incidence of joint symptoms was115(62.8%).Gastrointestinal bleeding occurred in 29 cases(15.8%).Among the 63 children with renal damage,12(19%)showed pure hematuria.There were 24 cases of pure proteinuria(38.1%).Hematuria with proteinuria accounted for 16 cases(25.4%).Nephrotic syndrome with or without hematuria in 2 cases(3.2%);There were 9 cases(14.3%)of nephritis.3.Univariate analysis: the X2 test was used for univariate analysis of the relevant counting data affecting renal injury in children with HSP.Conclusions: age ?6 years,frequency of rash recurrence ?3times,and gastrointestinal bleeding were significantly different between groups(P<0.05).Gender,respiratory tract infection,skin rash duration ?2 weeks,abdominal pain,joint pain,CRP?8.2mg/L,ESR?15mm/h had no statistical significance between the two groups(P> 0.05).Single factor analysis of the related measurement data affecting renal injury in children with HSP was performed by t test.Results: platelet count was significantly different between groups(P<0.05).Whiteblood cell count,Ig A,Ig G,Ig M,C3 and C4 levels were not statistically significant in comparison between the two groups(P>0.05).4.Multivariate analysis:In this study,multivariate Logistic regression analysis was performed for the age ?6 years,rash recurrence ?3 times,gastrointestinal bleeding,platelet count and other risk factors with statistical significance screened by univariate analysis.Conclusions: age ?6 years,frequency of rash recurrence ?3 times,gastrointestinal bleeding,increased platelet count were risk factors for renal damage in children with HSP(P<0.05).CONCLUSIONS:1.The incidence of allergic purpura renal injury in children was 34.4%.2.Age ?6 years,rash recurrence ?3 times,gastrointestinal bleeding,increased platelet count may be risk factors for renal damage in children with HSP.For HSP children with the above risk factors,monitoring and follow-up should be strengthened,and early active treatment should be conducted to avoid the progressive development of renal damage.