Abstract
BackgroundHenoch-Schönlein purpura nephritis (HSPN) is the most common pediatric secondary glomerular disease. This study aimed to investigate the significance of glomerular fibrinogen (Fib) deposition in children with HSPN.MethodsEighty-two patients with HSPN were enrolled retrospectively at the Children’s Hospital of Soochow University from January 2015 to March 2017. Patients were divided into groups according to the presence or absence and intensity of glomerular Fib deposits, and clinical and pathological features were compared among the groups.ResultsGlomerular Fib deposition was observed in 64 children (78.05%), including 1 Fib± case (1.22%), 23 Fib+ cases (28.05%), 37 Fib++ cases (45.12%), and 3 Fib+++ cases (3.66%). Significantly different levels of high-sensitivity C-reactive protein (hs-CRP), D-dimer (DD), proportions of CD19 + CD23+ cells and urine microalbumin:creatinine ratios (UMA/Cr) were noted among the different Fib deposition groups (no, mild and severe). Pairwise comparison in multiple groups revealed significantly increased hs-CRP, proportion of CD19 + CD23+ cells and UMA/Cr in the severe deposition group compared with the mild and no deposition groups, and remarkably increased DD levels were noted in the severe and mild deposition groups compared with the no deposition group. The degree of glomerular Fib deposition was positively correlated with the degree of glomerular IgA deposition, and the incidence of glomerular IgG deposition in the severe deposition group was increased compared with the no deposition group.ConclusionHSPN children with glomerular Fib deposition, especially those with severe Fib deposition, exhibit more severely disordered immunologic function, inflammatory reactions and hypercoagulability; glomerular damage in these patients may also be more severe.
Highlights
Henoch-Schönlein purpura nephritis (HSPN) is the most common pediatric secondary glomerular disease
Previous studies have suggested that Fib/fibrin is involved in various renal diseases in children [4], including HSPN
Global, granular Fib deposition in the mesangial regions and capillary loops was identified in 64 patients (78.05%), and the intensity of Fib deposition ranged from ± to ++ + (Fib±: n = 1; Fib+: n = 23; Fib++: n = 37; Fib+++: n = 3)
Summary
Henoch-Schönlein purpura nephritis (HSPN) is the most common pediatric secondary glomerular disease. This study aimed to investigate the significance of glomerular fibrinogen (Fib) deposition in children with HSPN. Henoch-Schönlein purpura nephritis (HSPN) is the most common secondary glomerular disease in children. Previous studies have suggested that Fib/fibrin is involved in various renal diseases in children [4], including HSPN. Recent reports have demonstrated that glomerular Fib deposition plays an important role in the pathogenesis of crescentic HSPN and that decreased Fib deposits predicts histological regression in children with crescentic HSPN [5, 6]. We aimed to further evaluate the clinical significance of glomerular Fib deposition by comparing clinical and pathological characteristics among groups with different degrees of Fib deposition
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