Relationship between renal pathology and clinical manifestations in children with Henoch-Schonlein purpura nephritis

Abstract

Objective To investigate the correlations between the clinical manifestations based on pathologic grades and renal pathological features of Henoch-Schonlein purpura nephritis(HSPN) in children. Methods The clinical data of 77 patients with HSPN in the Department of Nephrology, Anhui Provincial Children's Hospital from Ja-nuary 2004 to March 2014 were retrospectively analyzed.The relationship between clinical manifestation and pathological features was analyzed. Results Among the 77 patients, 21 cases(27.3%) had both abdominal symptoms, and arthritis was reported in 15 cases(19.5%), 28 cases(36.4%) had abdominal symptoms and arthritis, and 13 cases(16.9%) had no such symptoms.Hematuria and proteinuria were the most common clinical types [48.1%(37/77 cases)], followed by simple hematuria or proteinuria[27.3%(21/77 cases)], nephrotic syndrome[23.4%(18/77 cases)], and chronic nephritis[1.3%(1/77 cases)]. The major of pathological changes in HSPN were grade Ⅱ[46.8%(36/77 cases)] and grade Ⅲ[45.5%(35/77 cases)], the minority of them were grade Ⅰ[6.5%(5/77 cases)] and grade Ⅳ[1.3%(1/77 cases)] .The severity of urine protein was positively associated with pathologic classification(rs=0.472, P=0.000). According to the glomerular deposition of immune complex, there were 6 types.The percen-tage of deposition of IgA+ IgM was 62.3%(48/77 cases), IgA+ IgG+ IgM was 19.5%(15/77 cases), IgA 14.3%(11/77 cases), that of IgA+ IgG 1.3%(1/77 cases), and the IgM 1.3%(1/77 cases), no Ig 1.3%(1/77 cases). In these cases, 76.6%(59/77 cases) had complements C3 deposition; pathologic stage characterized by Ⅲ level and above were common[54.2%(32/59 cases)], Ⅱ level 42.2%(25/29 cases), Ⅰ level 3.4% (2/59 cases). Among the different types of immune complex depositions, there was no statistically significant difference in pathological types of distribution, while the clinical type and complements C3 deposition were significantly associated with pathologic classification(rs=0.361, P=0.001). Sixty-two cases were rated as level 1 (80.5%), and 15 cases was level 2 (19.5%); in different clinical group, rating in glomeruli was statistically different(χ2=17.2, P=0.004). Renal tubular interstitial rating of all the patients were level 1 (100%). Conclusions The severity of urine protein, complements C3 deposition is associated with pathologic classification.Pathologic classification can basically reflect the renal damage in HSPN. Key words: Henoch-Schonlein purpura nephritis; Child; Clinical manifestation; Renal pathology