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Prediction of renal outcome in Henoch-Schonlein nephritis based on biopsy findings.

ABSTRACT:

Background

In Henoch-Schönlein nephritis (HSN), a risk factor for unfavorable outcome is prolonged proteinuria, but the value of renal biopsies in prognosis assessment is debatable.

Methods

We evaluated serial renal biopsies from 26 HSN patients. Follow-up biopsy occurred at median 2.1 years after diagnostic biopsy. Patients formed two groups at the follow-up biopsy: patients without proteinuria (group I; n = 11) and with proteinuria (group II; n = 15). Biopsies underwent evaluation according to three classifications: International Study of Kidney Disease in Children (ISKDC), Oxford (MEST-C), and semiquantitative classification (SQC) including an activity and chronicity score. Analysis also included expression of pro-fibrotic (alpha-smooth muscle actin and vimentin) and inflammatory (P-selectin glycoprotein ligand-1) molecules in the diagnostic biopsy specimens. Definition of unfavorable outcome was active renal disease or reduced renal function at last follow-up.

Results

Between the biopsies, SQC chronicity score increased in 22 (85%) patients, whereas activity score and ISKDC grade decreased in 21 (81%) and 17 (65%), respectively. Of the MEST-C parameters, endocapillary proliferation (from 83 to 13%; p < 0.001) and crescents (from 63 to 25%; p = 0.022) showed significant reduction, and segmental glomerulosclerosis (from 38 to 79%; p = 0.006) significant increment. These changes occurred similarly in groups I and II. Expression of the pro-fibrotic and inflammatory molecules showed no clinically significant differences between groups I and II. None in group I and five (33%) patients in group II had unfavorable outcome (p = 0.053).

Conclusions

Our results suggest that follow-up biopsies provide limited additional information to clinical symptoms in HSN outcome prediction.

SUBMITTER: Koskela M

PROVIDER: S-EPMC7056733 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Prediction of renal outcome in Henoch-Schönlein nephritis based on biopsy findings.

Koskela Mikael M Ylinen Elisa E Autio-Harmainen Helena H Tokola Heikki H Heikkilä Päivi P Lohi Jouko J Jalanko Hannu H Nuutinen Matti M Jahnukainen Timo T

Pediatric nephrology (Berlin, Germany) 20191203 4

<h4>Background</h4>In Henoch-Schönlein nephritis (HSN), a risk factor for unfavorable outcome is prolonged proteinuria, but the value of renal biopsies in prognosis assessment is debatable.<h4>Methods</h4>We evaluated serial renal biopsies from 26 HSN patients. Follow-up biopsy occurred at median 2.1 years after diagnostic biopsy. Patients formed two groups at the follow-up biopsy: patients without proteinuria (group I; n = 11) and with proteinuria (group II; n = 15). Biopsies underwent evaluati ...[more]

PMID: 31797094

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