Abstract
This study aimed to assess the relevance of laboratory tests in Henoch-Schönlein purpura nephritis (HSPN) classification, and determine accurate classification factors. This prospective study included 694 HSPN patients who underwent ultrasound-guided percutaneous renal biopsy (PRB). Renal specimens were scored according to International Study of Kidney Disease in Children (ISKDC) classification. Meanwhile, blood samples were immediately collected for laboratory examination. The associations between laboratory parameters and HSPN classification were assessed. Significant differences in levels of serum Th1/Th2 cytokines, immunoglobulins, T-lymphocyte subsets, complement, and coagulation markers were obtained between HSPN patients and healthy children. Interestingly, 24h urinary protein (24h-UPRO) levels and urine protein/urine creatinine ratios could determine HPSN grade IIb, IIIa, and IIIb incidences, with areas under ROC curve of 0.767 and 0.731, respectively. At 24h-UPRO >580.35mg/L, prediction sensitivity and specificity were 75.2% and 70.0%, respectively. These values became 53.0% and 82.3%, respectively, with 24h-UPRO exceeding 1006.25mg/L. At urine protein/urine creatinine > 0.97, prediction sensitivity and specificity were 65.5% and 67.2%, respectively, values that became 57.4% and 80.0%, respectively, at ratios exceeding 1.2. Cell and humoral immunity, coagulation and fibrinolytic systems are all involved in the pathogenesis of HSPN, and type I hypersensitivity may be the disease trigger of HSPN. 24h-UPRO levels and urine protein/creatinine ratios could probably forecast the pathological classification of HSPN.
Highlights
Henoch-Schönlein Purpura (HSP) is a small vessel vasculitis with variable clinical features such as skin purpura, arthritis and/or arthralgia, kidney damage, and gastrointestinal disease
Urine protein contents in children with Henoch-Schönlein purpura nephritis (HSPN) were negatively correlated with CD4+ cell amounts and CD4+/CD8+ ratios, suggesting a T cell dysfunction and a hyperfunctional cellular immunity in HSPN patients
Th1 cells secrete Th1 cytokines such as IFN-γ and tumor necrosis factor (TNF)-α; Th2 cells produce IL-4, IL-6 and IL-10 that are known as Th2 cytokines
Summary
Henoch-Schönlein Purpura (HSP) is a small vessel vasculitis with variable clinical features such as skin purpura, arthritis and/or arthralgia, kidney damage, and gastrointestinal disease. Renal HSP, known as Henoch-Schönlein purpura nephritis (HSPN), is the most serious complication, and a key factor affecting patient prognosis [1, 2]. The extent of renal injury is PLOS ONE | DOI:10.1371/journal.pone.0127767. Laboratory Parameters and HSPN Types had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
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