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Histological prognostic factors in children with Henoch-Schönlein purpura nephritis

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Abstract

Background

The management of IgA vasculitis with nephritis (IgAVN) remains controversial because of the difficulty to identify prognostic factors. This study reports the prognosis of children with IgAVN in relation to histological parameters.

Methods

All children with IgAVN diagnosed between 2000 and 2015 in three pediatric nephrology centers were included. The following histological parameters were analyzed: mesangial proliferation (MP), endocapillary proliferation (EP), crescents, active, or chronic tubular and interstitial lesions (TIa lesions/TIc lesions), and segmental glomerulosclerosis (GS). Clinical and biological data were collected at the time of renal biopsy. The primary endpoint was IgAVN remission defined as a proteinuria < 200 mg/l without renal failure.

Results

One hundred fifty-nine children were included with a median age of 7.6 years. Acute glomerular or TI lesions including MP, EP, crescents, and TIa lesions were observed, respectively, in 81%, 86%, 49%, and 21% of patients. Chronic glomerular lesions including GS and TIc lesions were observed in 6 and 7% of patients. Median initial proteinuria was 330 mg/mmol, albuminemia 32 g/l, and eGFR 110 ml/min/1.73 m2. One hundred twelve (70%) patients were in remission at the end of a median follow-up of 37.4 months. Chronic lesions were significantly associated with the absence of remission in multivariate analysis, whereas EP, crescents and TIa were not associated with a poor prognosis.

Conclusions

Of children with IgAVN, 30% present a persistent renal disease at the end of a 3-year follow-up. Chronic histological lesions, but not EP or crescents, are associated with a bad prognosis and must be evaluated in IgAVN histological classification.

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Authors and Affiliations

  1. Pediatric Nephrology unit, Trousseau Hospital, APHP.6, DMU Origyne, 26 Avenue du Docteur Arnold Netter, 75012, Paris, France

    Jean-Daniel Delbet, Guillaume Geslain, Martin Auger, Cyrielle Parmentier & Tim Ulinski

  2. Sorbonne Université, Paris 6, Paris, France

    Jean-Daniel Delbet & Tim Ulinski

  3. Pediatric Nephrology, Robert Debré Hospital, APHP, Paris, France

    Julien Hogan, Michel Peuchmaur & Georges Deschênes

  4. University Paris Diderot, Paris 7, Paris, France

    Julien Hogan & Georges Deschênes

  5. Pediatric Nephrology, Necker Enfants Malades, APHP, Paris, France

    Rémi Salomon

  6. Pathology Department, Tenon Hospital, APHP, Paris, France

    David Buob

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  1. Jean-Daniel Delbet
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Correspondence to Jean-Daniel Delbet.

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Delbet, JD., Geslain, G., Auger, M. et al. Histological prognostic factors in children with Henoch-Schönlein purpura nephritis. Pediatr Nephrol 35, 313–320 (2020). https://doi.org/10.1007/s00467-019-04363-y

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