Clinical analysis of Henoch-Schönlein purpura nephritis with mild proteinuria in children

Abstract

Objective To analyze the clinical feature and prognosis of Henoch-Schonlein purpura nephritis (HSPN) with mild proteinuria in children. Methods The data of 78 HSPN children with mild proteinuria who were hospitalized in Children′s Hospital Affiliated to Capital Institute of Pediatrics from September 2013 to September 2016 were retrospectively analyzed.All the cases were followed up.The clinical manifestation, histologic characteristics, treatment and outcome were analyzed, and the prognosis was compared between groups of different levels of proteinuria. Results (1)In the 78 cases, 45 cases were male and 33 cases were female.The attack age range was from 3 years and 8 months to 14 years and 3 months, and the renal involvement occurred from 1 day to 60 months in courses of Henoch-Schonlein purpura.(2)Twenty-seven cases were manifested with isolated proteinuria, and 51 cases were with hematuria and proteinuria.All the cases had normal kidney function while 2 cases had hypertension.Renal biopsy was performed in 9 cases, in which 6 cases were Ⅲb, the other 3 cases were Ⅱb.(3)Twelve cases were treated with regimen of immunosuppression and/or glucocorticoid.By the end of follow-up, the urinary analysis showed 46 cases(50.9%) had completely recovered, 29 cases(37.2%)just had microscopic hematuria but no proteinuria, and 3 cases(3.8%) had obvious proteinuria.The renal involvement of 7 cases (9%) had been recurrent during the follow-up.(4) The time of recovery of proteinuria in the group with urinary protein ≤15 mg/kg(median: 1 month) was less than that of the group with urinary protein >15 mg/kg(median: 3 months), and the difference was significant (Z=-4.12, P=0.001), and 6 cases were found recurrent in the former group (10.9%) but 1 case(4.3%) in the latter group, and the difference was not significant(χ2=0.24, P=0.624). Conclusions The clinical characteristics of children with HSPN with mild proteinuria are not serious, and most of the cases had a favorable prognosis.However, some cases have protracted and recurrent courses which have serious pathological grade.So, urine analysis, long term follow-up, timely kidney biopsy and appropriate treatment are significant for HSPN with mild proteinuria. Key words: Henoch-Schonlein purpura nephritis; Child; Proteinuria; Prognosis