Application Of The Oxford Classification Of IgA Nephropathy In Children With Henoch-sch?nlein Purpura Nephritis

BackgroundAt present,the severity of Henoch-Sch?nlein purpura nephritis(HSPN)is classified according to the International Study of Kidney Disease in Children(ISKDC)classification standard,and its content is mainly based on the percentage of crescents,Ignoring the influence of other pathological types on its prognosis,so some scholars believe that ISKDC classification cannot accurately determine the prognosis.Recent studies have found that IgAN Oxford Classifification(The Oxford Classifification)is related to the long-term effects of HSPN,but only a small number of children progress to end-stage renal disease(ESRD).Studies have shown that proteinuria remission can be used as the end point to evaluate the application of Oxford pathology in children with HSPN.ObjectiveTo analyze the impact of pathological changes in the Oxford pathological classification on the remission of proteinuria in 30 HSPN children admitted to the First Affiliated Hospital of Xinxiang Medical University in the past 5 years,To further explore the application of Oxford pathological classification in children with HSPN.MethodsWe retrospectively analyzed the clinical data of children diagnosed with IgAN and HSPN from December 2014 to December 2019 in the First Affiliated Hospital of Xinxiang Medical University,and compared the baseline data of the two groups.According to Oxford pathological classification,the renal pathological results of HSPN were reclassified.The Kaplan-Meier method was used to draw the survival curve,and the COX univariate and multivariate regression models were established to analyze the independent influencing factors of proteinuria remission,with P<0.05 as the difference There is statistical significance.Results1.In this study,a total of 30 children with HSPN and 28 children with IgAN were collected.Among them,17 male children in the HSPN group accounted for 56.7%,and 20 male children in the IgAN group accounted for 71.4%.There was no statistical difference in the proportion of males between the two groups(P>0.05);two groups of 24-hour urine protein quantification,the number of people treated with oral corticosteroids alone,the number of people treated with immunosuppressive drugs alone,the number of people treated with oral corticosteroids combined with immunosuppressive drugs,the number of high-dose methylprednisolone,the number of ACEI and ARB treatments,the number of nephropathy There was no statistical difference in the number of people and the follow-up time(P>0.05);The age of onset in the HSPN group was smaller than that of the IgAN group(P<0.05),the e GFR of the HSPN group was significantly greater than that of the IgAN group(P<0.05),and the time from onset to Kidney biopsy was longer in the HSPN group than in the IgAN group(P<0.05).After follow-up,the average time of proteinuria remission in the HSPN group was significantly shorter than that of the IgAN group(P<0.05).In the IgAN group,there were 6 cases of renal impairment,26 cases of proteinuria remission,2 cases of persistent proteinuria,and 0 cases of end-stage renal disease;In the HSPN group,there were 0 cases of impaired renal function,26 cases of remission of proteinuria,4 cases of persistent proteinuria,and 0 cases of end-stage renal disease.In the HSPN group,18 cases had no renal manifestations at first,and 12 cases had renal manifestations at the beginning;E1(endocapillary hypercellularity)and ISKDC III and IV in the renal manifestations group were significantly more than those in the no renal manifestations group(P<0.05);while there were no differences in age,sex,clinical manifestations,glomerular filtration rate(e GFR),24-hour urinary protein quantification,M1(mesangial hypercellularity),S1(segmental glomerulosclerosis),C1 and C2(crescents),and remission of proteinuria between the initial no-renal manifestation group and the initial renal manifestation group(P > 0.05).2.In HSPN group E1(endocapillary hypercellularity),S1(segmental glomerular sclerosis),ISKDC Ⅲ and Ⅳ,High-dose methylprednisolone treatment was significantly more than E0,S0,ISKDC Ⅰ and Ⅱ(66.7% VS 16.7%、66.7% VS 9.5%、50.0% VS 6.3%).3.The survival curve drawn by Kaplan-Meier method shows that the proteinuria remission rate of E1,C1 and C2 group in Oxford classification is significantly lower than that of E0,C0 group,and the remission rate of proteinuria of ISKDC Ⅲ and Ⅳ is significantly lower than that of ISKDC Ⅰ and Ⅱ(P<0.05).4.Univariate COX regression analysis E1,C1 and C2,ISKDC Ⅲ and Ⅳ grades have statistically significant effects on proteinuria remission(P<0.05),while M1,S1 have no statistically significant effects on proteinuria remission(P>0.05).5.Multivariate COX regression analysis showed that E1 was an independent risk factor for remission of proteinuria in the short term(P<0.05).ConclusionsIn the Oxford pathological classification of IgA nephropathy,endocapillary hypercellularity(E1)is an independent risk factor for proteinuria remission in children with HSPN.Therefore,the Oxford pathological classification has certain application value for evaluating the remission of proteinuria of HSPN in children.