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Risk factors associated with renal crescentic formation in pediatric Henoch-Schonlein purpura nephritis: a retrospective cohort study.

ABSTRACT: BACKGROUND:The long-term prognosis of Henoch-Schönlein purpura (HSP) depends on the severity of renal involvement, and crescent formation is considered an important risk factor for poor prognosis of Henoch-Schönlein purpura nephritis (HSPN). The objective of this study was to evaluate factors affecting crescent formation in children with HSPN. METHODS:Demographic factors, clinical characteristics, and laboratory data of children with HSPN with or without crescents were retrospectively analyzed. Univariate and multivariate logistic regression analyses were used to determine the risk factors of crescent formation in HSPN. RESULTS:A total of 191 children with HSPN were enrolled in the study. There were 107 (56%) males and 84 (44%) females, with a median age of 7?years (range: 2?years-15?years). International Study of Kidney Disease in Children (ISKDC) grading was used to divide subjects into two groups: those without glomerular crescent formation (ISKDC grades I-II, n?=?146 cases) and those with glomerular crescent formation (ISKDC grades III-V, n?=?45 cases). Logistic regression analysis showed that higher urinary white blood cell (WBC) count (OR?=?3.300; 95% CI, 1.119-9.739; P?=?0.0306) and higher urinary microalbumin/creatinine ratio (ACR) (OR?=?25.053; 95% CI, 1.354-463.708; P?=?0.0305) were independent risk factors for the formation of crescents in HSPN. The area under the receiver operating characteristic curve of urinary WBC and ACR were 0.753 and 0.698 respectively, with the Hosmer and Lemeshow goodness-of-fit test (P?=?0.0669, P?>?0.05). CONCLUSION:These results suggest that higher urinary WBC count and ACR should be strictly monitored for children with HSPN. Adequate clinical intervention for these risk factors may limit or prevent renal crescent formation.

SUBMITTER: Song YR

PROVIDER: S-EPMC7604931 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Risk factors associated with renal crescentic formation in pediatric Henoch-Schönlein purpura nephritis: a retrospective cohort study.

Song Yong-Rui YR Guo Wan-Liang WL Sheng Mao M Lin Qiang Q Zhu Xue-Ming XM Li Xiao-Zhong XZ

BMC pediatrics 20201102 1

<h4>Background</h4>The long-term prognosis of Henoch-Schönlein purpura (HSP) depends on the severity of renal involvement, and crescent formation is considered an important risk factor for poor prognosis of Henoch-Schönlein purpura nephritis (HSPN). The objective of this study was to evaluate factors affecting crescent formation in children with HSPN.<h4>Methods</h4>Demographic factors, clinical characteristics, and laboratory data of children with HSPN with or without crescents were retrospecti ...[more]

PMID: 33131493

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Project description:BACKGROUND:Henoch-Schönlein purpura nephritis (HSPN) is a form of small vessel vasculitis associated with purpura and IgA deposition in the glomeruli. The International Study of Kidney Disease in Children (ISKDC) classification predicts renal prognosis in children with HSPN, but not in adults. Additionally, it is not well known whether the Oxford classification 2016 and/or the Japanese Histologic classification (JHC) are associated with renal outcome. Herein, we investigated the relationship between pathological characteristics and renal outcome among adult patients with HSPN. METHODS:A multicenter retrospective cohort study was conducted in adult patients with HSPN who underwent renal biopsy between 2004 and 2014. Two nephrologists classified each patient according to the Oxford classification 2016, JHC, and the ISKDC classification. Renal outcome was defined by a 30% decline in the eGFR and/or end-stage kidney disease. RESULTS:We enrolled 74 adult patients with HSPN (mean age, 47.8?±?17.4 years; mean eGFR, 76.4?±?25.8 ml/min/1.73 m2; median proteinuria, 1.40 [IQR: 0.70-2.38] g/day). During a mean follow-up period of 68.0?±?33.0 months, fourteen patients (18.9%) reached the renal outcome, and all 14 had received immunosuppressive therapy. The log-rank test revealed that event-free renal survival was significantly shorter in patients with endocapillary proliferation (E1) according to the Oxford classification than in those with E0 (p?=?0.0072). However, the JHC, ISKDC classification and other Oxford lesions could not demonstrate a significant difference in event-free renal survival. In a multivariate Cox model adjusted for clinical and pathological factors, age (HR, 1.57; 95% CI, 1.12-2.21) and E lesion (HR, 6.71; 95% CI, 1.06-42.7) were independent risk factors for renal outcome. CONCLUSIONS:Endocapillary proliferation is significantly associated with renal outcome in adult patients with HSPN, including those receiving immunosuppressive therapy. Other Oxford classification lesions, JHC, and ISKDC classification were not associated with renal outcome.

Dataset Information

Risk factors associated with renal crescentic formation in pediatric Henoch-Schonlein purpura nephritis: a retrospective cohort study.

Publications

Risk factors associated with renal crescentic formation in pediatric Henoch-Schönlein purpura nephritis: a retrospective cohort study.

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