Clinical And Pathological Comparative Study Of Childhood IgA Nephropathy And Purpuric Nephritis

Objective:To characterize the relationship between IgA nephropathy(OgAN)and Henoch-Schonlein purpura nephritis(HSPN)in children through comparison of their clinical manifestations and pathological changes.Methods:Children diagnosed IgAN by renal biopsy between January 2012 and September 2016 and children diagnosed HSPN by renal biopsy between January 2014 and September 2016 in Department of Nephrology,Nanjing Children's Hospital were selected and analysised retrospectively.They were divided into three groups according to the level of 24-h urinary protein excretion:mild,moderate and severe urine protein groups.Compare the clinical and pathological differences between children with IgAN and HSPN in the same group.Including gender,age,incidence rate of gross hematuria,24 hours urine protein excretion,renal function(serum urea and creatinine),serum immunoglobulin(IgA,IgG and IgM)and complement(C3 and C4),incidence rate of glomerular lesions(incidence rate of endothelial hyperplasia,loop necrosis and crescent formation,glomerular sclerosis,balloon adhesions),degree of tubulointerstitial lesions,intensity of the immunoglobulin(IgA,IgG and IgM),complement(C3 and Clq)and fibrinogen(FRA)deposition,treatment and prognosis.Results:There were no significant differences in gender and age between IgAN nephropathy and HSPN(P>0.05).The incidence of gross hematuria of IgAN was significantly higher than that of HSPN in the same group(P<0.01).There was no significant differences in the level of serum urea,creatinine,serum IgA,IgG,IgM,C3 and C4 between the IgAN and HSPN in the same group(P>0.05).In renal pathology,finterstitial fibrosis,tubular atrophy,interstitial infiltration of inflammatory cells were more common in IgAN compared with HSPN in the same group(P<0.01).In addition,in mild proteinuria group,balloon adhesions and tubular cast were more common in IgAN versus HSPN.The renal interstitial score of IgAN was much higher than that of HSPN,the differences were significantly(P<0.01).The fluorescence intensity of IgA,IgG and C3 deposition in children with IgAN with mild proteinuria was higher than that of HSPN,and the differences were significantly(P<0.01).The FRA fluorescence intensity of HSPN in both mild and severe proteinuria groups were higher than that in IgAN(P<0.01).In our hospital,children with HSPN were more common being treated with hormone compared with children with IgAN in mild albuminuria group.The rate of proteinuria elimination of IgAN within 3 months was higher than that of HSPN in the same group(P<0.01)Conclusions:Significant clinico-pathological differences can be found between HSPN and IgAN in children,which did not support the standpoint of a one disease entity.