scholarly journals Using MEST-C Scores and the International Study of Kidney Disease in Children Classification to Predict Outcomes of Henoch–Schönlein Purpura Nephritis in Children

2021 ◽  
Vol 9 ◽  
Author(s):  
Meiqiu Wang ◽  
Ren Wang ◽  
Xu He ◽  
Pei Zhang ◽  
Qianhuining Kuang ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Primary Outcome ◽  
International Study ◽  
Renal Outcome ◽  
Oxford Classification ◽  
Henoch Schonlein Purpura ◽  
Significant Difference ◽  
Schonlein Purpura ◽  
Henoch Schönlein Purpura ◽  
Purpura Nephritis

Introduction: Henoch–Schönlein purpura nephritis (HSPN) and IgA nephropathy (IgAN) bear similarities in some aspects. The histological classification of HSPN was built on the International Study of Kidney Disease in Children (ISKDC) criteria, while IgAN was established on the 2016 Oxford classification (MEST-C scores). The purpose of this paper was to discuss the predictive value of the ISKDC classification and MEST-C scores in children with HSPN.Methods: We performed a retrospective study of 877 children with HSPN in a single center between 2001 and 2019. The primary outcome was defined as chronic kidney disease—estimated glomerular filtration rate (eGFR) <90 ml/min/1.73 m2.Results: During the follow-up period of 23.3 (10.9–47.9) months, 51 (5.8%) patients reached the primary outcome. As revealed in a Kaplan–Meier plot, segmental glomerulosclerosis (S) (P < 0.001) and tubular atrophy/interstitial fibrosis (T) (P < 0.001) significantly predict poor renal outcome. Other Oxford lesions and the ISKDC classification, however, did not show a significant difference in a worse outcome. In a multivariate Cox model adjusted for pathological and clinical factors, eGFR [hazard ratio (HR) = 2.831, 95% confidence interval (95% CI) = 1.359–5.896], S lesion (HR = 3.936, 95% CI = 2.078–7.457), and T lesion (HR = 4.002, 95% CI = 1.733–9.242) were independent risk factors for the renal outcome.Conclusion: This series constitutes the largest series reported so far in the literature of such patients. According to our findings, S and T of the Oxford classification, which are ignored by the ISKDC classification, could be applied to predict the renal prognosis of children with HSPN.

scholarly journals Biopsy-proven Henoch-Schönlein purpura nephritis: a single center experience

2020 ◽  
Author(s):  
Eda Didem Kurt-Şükür ◽  
Thivya Sekar ◽  
Kjell Tullus
Keyword(s):  
Angiotensin Receptor Blockers ◽  
Laboratory Data ◽  
Treatment Modalities ◽  
Oxford Classification ◽  
Henoch Schonlein Purpura ◽  
Nephritic Syndrome ◽  
Kidney Involvement ◽  
Schonlein Purpura ◽  
Henoch Schönlein Purpura ◽  
Purpura Nephritis

Abstract Background Knowledge on normal progress and treatment of Henoch-Schönlein purpura nephritis (HSPN) is limited. This study reviews outcome, clinical, pathological, and therapeutic factors affecting the prognosis of HSPN patients. Methods Forty-nine children with biopsy-confirmed HSPN diagnosed between September 2008 and 2018 were included. Demographics, clinical and laboratory data, treatment, and outcome were recorded at the time of biopsy, 3, 6, 12, and 24 months and at last visit. Clinical outcome was graded according to Meadow’s criteria. Results The median age at time of biopsy was 10.1 years (IQR:5.7) and female/male ratio 24/25. At presentation, 40.8% of patients had nonnephrotic proteinuria, 18.4% nephrotic syndrome (NS), 4.1% nephritic syndrome (NephrS), and 36.7% NephrS+NS. There were 11 patients with an estimated glomerular filtration rate below 90 ml/min/1.73 m2. Biopsy specimens were classified according to International Study of Kidney Diseases in Children (ISKDC) and Oxford Classification MEST-C scoring systems. Forty-one patients received angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, 37 patients steroids, and 35 patients other immunosuppressive medications. At last visit, 24 patients had stage 1 chronic kidney disease (CKD), three stage 2 CKD, and two had stage 5 CKD. Neither clinical parameters nor ISKDC biopsy grade or treatment modalities effected the final outcome. The Oxford classification showed significantly increased segmental glomerulosclerosis in patients with unfavorable outcome. Favorable outcome was associated with shorter time from kidney involvement to biopsy and start of treatment. Conclusion A large proportion of patients continued to show signs of CKD at last follow-up while only a small proportion developed stage 5 CKD.

scholarly journals Tubulointerstitial Infiltration of M2 Macrophages in Henoch-Schönlein Purpura Nephritis Indicates the Presence of Glomerular Crescents and Bad Clinical Parameters

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Jisup Kim ◽  
Sung-Eun Choi ◽  
Keum Hwa Lee ◽  
Hyeon Joo Jeong ◽  
Jae Il Shin ◽  
...  
Keyword(s):  
Systemic Vasculitis ◽  
Renal Involvement ◽  
International Study ◽  
Clinical Parameters ◽  
M2 Macrophages ◽  
Henoch Schonlein Purpura ◽  
Severe Manifestation ◽  
Schonlein Purpura ◽  
Henoch Schönlein Purpura ◽  
Purpura Nephritis

Henoch-Schönlein purpura (HSP) is the most common systemic vasculitis in children, and renal involvement (HSP nephritis, HSPN) is a severe manifestation. HSPN is histologically classified by the International Study of Kidney Disease in Children (ISKDC) based on mesangial hypercellularity and the extent of glomerular crescents. Macrophages, categorized as M1 or M2, frequently infiltrate in various glomerular and tubulointerstitial diseases and infiltration of specific subtypes is associated with disease progression. Therefore, to identify whether infiltration of M1 or M2 macrophages has clinical significance, we quantified the subtypes of macrophages in 49 HSPN specimens and correlated the counts with histologic features and clinical parameters. Higher tubulointerstitial M2 counts were associated with chronic renal failure (CRF), ISKDC classes III-IV, and crescents (P<0.001, 0.002, 0.001). Glomerular M2 counts were significantly related to ISKDC classes III-IV and crescents (area under curve, AUC 0.804, 0.833). Tubulointerstitial M2 counts were associated with CRF, ISKDC classes III-IV, and crescents (AUC 0.872, 0.778, 0.830). Tubulointerstitial M2 counts also revealed higher AUC than tubulointerstitial M1 counts for CRF (P=0.036) and ISKDC classes III-IV (P=0.047). Glomerular M2 counts revealed higher AUC than glomerular M1 counts for ISKDC classes III–IV (P=0.024). Tubulointerstitial M2 counts were the most powerful parameter for CRF (AUC 0.872) and revealed even higher AUC than ISKDC classification (AUC 0.716) with borderline significance (P=0.086) for CRF. In summary, tubulointerstitial M2 counts were a superior parameter to tubulointerstitial M1 counts and even to ISKDC classification indicating the presence of CRF.

scholarly journals Endocapillary Proliferation was Associated with Unfavorable Outcomes in Children with Henoch-Schönlein Purpura Nephritis and IgA Nephropathy

2020 ◽  
Author(s):  
Supatjaree Chanvitan ◽  
Kanchana Tangnararatchakit ◽  
Pawaree Saisawat ◽  
Songkiat Chantarogh ◽  
Suchin Worawichawong ◽  
...  
Keyword(s):  
Iga Nephropathy ◽  
Clinical Outcomes ◽  
Limited Resource ◽  
Limited Data ◽  
Oxford Classification ◽  
Henoch Schonlein Purpura ◽  
Schonlein Purpura ◽  
Henoch Schönlein Purpura ◽  
Purpura Nephritis

Abstract Introduction: There are limited data on the outcomes in children with Henoch-Schönlein purpura nephritis (HSPN) and IgA nephropathy (IgAN) in limited-resource countries. This study was aimed to evaluate the outcome of HSPN and IgAN and to evaluate the pathological findings associated with unfavorable outcomes.Materials and methods: This was a retrospective study conducted in children (≤18 years) diagnosed with HSPN or IgAN, had estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m2 and underwent renal biopsy between year 2002 - 2018 at Ramathibodi Hospital, Bangkok, Thailand. Clinical outcomes were graded according to the outcome classification by Counahan, as follows: favorable [A, normal; B, minor urinary abnormalities (proteinuria < 1 g/1.73 m2/day)]; unfavorable [C, active renal disease (proteinuria > 1 g/1.73 m2/day and/or hypertension); D, renal insufficiency (eGFR < 60 mL/min/1.73 m2 or died)]. Pathologies were graded according to Oxford classification.Results: A total of 47 patients (28 HSPN and 19 IgAN) were included with means of age at 9.4 ± 2.8 vs 11.3 ± 4.3 years, respectively. After a median follow-up time of 50 months, proportions of favorable outcomes in the patients with HSPN and IgAN were 82.1% (23/28) and 89.5% (17/19), respectively (p-value = 0.685). In multivariate analysis, only endocapillary proliferation (E) was associated with unfavorable outcomes in both diseases with the odds ratio (95% CI) of 12.46 (1.36 - 114.51, p-value = 0.026).Conclusion: The clinical outcomes of most patients with HSPN and IgAN were favorable and comparable. Endocapillary proliferation (E) was the only factor associated with poor outcome in both diseases.

scholarly journals HENOCH-SCHÖNLEIN PURPURA NEPHRITIS IN CHILDREN: EXPERI-ENCE OF THE TWO TERTIARY CARE CENTERS FOR PEDIATRIC AND ADOLESCENT RHEUMATOLOGY OF THE REPUBLIC OF CROATIA FROM 2006 TO 2017

2018 ◽  
Vol 141 (5-6) ◽  
pp. 115-126
Keyword(s):  
Kidney Disease ◽  
Tertiary Care ◽  
University Hospital ◽  
Henoch Schonlein Purpura ◽  
Renal Complications ◽  
Number Of Patients ◽  
Isolated Proteinuria ◽  
Schonlein Purpura ◽  
Henoch Schönlein Purpura ◽  
Purpura Nephritis

Aim: To determine types of renal complications, indications for biopsy, treatment methods and possible outcomes in patients with Henoch-Schönlein purpura nephritis. Patients and methods: Retrospective analysis of medical data of HSP patients treated at the Department of Paediatrics, University Hospital Centre Zagreb, and the Department of Paediatrics, University Hospital Centre Split, during the period from 2006 to 2017, who developed kidney disease according to EULAR/PRINTO/PRES criteria. Results: Out of 378 patients diagnosed with HSP, 81 (21.4%) developed kidney disease, out of whom 43 boys (53.1%) and 38 girls (46.9%), with the median age 8.4 years (2.5–16.8).. A statistically significant increase of patients with HSP was during autumn and winter. There is a greater chance of nephritis with the increase of patients age at diagnosis. For every year (from 1 to 17 years) the chances increase by around 2.25%. Equal number of patients, 44.45%, had both hematuria and proteinuria or isolated hematuria, and only 11.1% isolated proteinuria. Renal biopsy was performed in 37 patients (45.7%), and most biopted patients were from concurrent hematuria and proteinuria group (70.3%). Children with isolated hematuria or with isolated proteinuria were most often treated with corticosteroids while children with hematuria and proteinuria were most often treated with corticosteroids and angiotensin-converting enzyme inhibitors. Immunosuppressives were used in 16% of the patients, including most of those in the group with concurrent hematuria and proteinuria (69.2%). Only one patient (1.2%) developed renal insufficiency with the need for dialysis, while the outcome of the others was evaluated as good. Conclusion: Renal complications are the most important factor in the outcome of patients with HSP. For the optimal treatment of these patients it is necessary to bring consensus about the indications for kidney biopsy in HSP, and also to validate the existing pathohistological classification to affirm which one best correlates with the adverse outcome of the disease.

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