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.

中文翻译：

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根据活检结果预测Henoch-Schönlein肾炎的肾结局。

摘要

背景

在Henoch-Schönlein肾炎（HSN）中，不良蛋白尿时间长是导致预后不良的危险因素，但肾活检在评估预后中的价值尚有争议。

方法

我们评估了26名HSN患者的系列肾脏活检。随访活检发生在诊断性活检后中位2.1年。在随访活检中，患者分为两组：无蛋白尿（I组；n = 11）和蛋白尿（II组；n = 15）。根据三种分类对活检进行评估：国际儿童肾脏病研究（ISKDC），牛津（MEST-C）和半定量分类（SQC），包括活动和慢性评分。分析还包括在诊断性活检标本中促纤维化（α-平滑肌肌动蛋白和波形蛋白）和炎性（P-选择蛋白糖蛋白配体-1）分子的表达。不良结局的定义是活动性肾脏疾病或最后一次随访时肾功能下降。

结果

在活检之间，SQC慢性评分在22例（85％）患者中增加，而活动评分和ISKDC评分分别在21例（81％）和17例（65％）降低。在MEST-C参数中，毛细血管内增生（从83％到13％; p <0.001）和新月形（从63％到25％; p = 0.022）显着降低，而节段性肾小球硬化（从38％到79％; p = 0.006） ）显着增加。这些变化在第一组和第二组中类似地发生。促纤维化和炎性分子的表达在I组和II组之间没有显示出临床上的显着差异。I组无一，II组有五名（33％）患者预后不良（p = 0.053）。

结论

我们的结果表明，随访活检仅能为HSN结果预测中的临床症状提供有限的其他信息。