Abstract
BackgroundHenoch-Schönlein purpura nephritis (HSPN) shares many similarities with IgA nephropathy. We aimed to analyze the predictive value of the International Study of Kidney Disease in Children (ISKDC) classification and the updated Oxford classification for IgA nephropathy in HSPN patients.MethodsData of 275 HSPN patients (aged≥14 years) were retrieved, and all of them underwent a renal biopsy. We re-classified the biopsies according to the ISKDC classification and the updated Oxford classification to analyze their correlations with clinical features and renal outcomes. The renal endpoints were defined as ≥30% reduction in baseline estimated glomerular filtration rate (eGFR) in 2 years, doubling of serum creatinine (Scr) or end stage renal disease.ResultsDuring follow-up period of 56(30,86) months, 30(10.9%) patients reached renal endpoints. Segmental sclerosis was the only pathological feature independently associated with renal endpoints (HR 4.086, 95%CI 1.111–15.026, P = 0.034). Tubular atrophy/ interstitial fibrosis was associated with eGFR and Scr levels, and its correlation with renal endpoints was found by univariate analysis. Endocapillary hypercellularity was associated with 24 h urine protein and is of prognostic value in univariate analysis. Mesangial hypercellularity was not associated with clinical features or renal endpoints. Crescents were associated with 24 h urine protein, Scr and eGFR levels, but both ISKDC and updated Oxford classifications of crescents were not associated with renal endpoints by multivariate analysis.ConclusionsThe updated Oxford classification can help in disease management and renal outcome prediction of HSPN.
Highlights
Henoch-Schönlein purpura nephritis (HSPN) shares many similarities with immunoglobulin A (IgA) nephropathy
Pathologic features of HSPN is usually graded by the International Study of Kidney Disease in Children (ISKDC) classification, mainly according to the existence and the number of crescents [8]
During a median follow-up of 56(30,86) months, 30(10.9%) patients reached renal endpoints including more than 30% decrease in baseline estimated glomerular filtration rate (eGFR) in 2 years (11 patients), doubling in serum creatinine (Scr) (7 patients) and end stage renal disease (ESRD) (12 patients)
Summary
Henoch-Schönlein purpura nephritis (HSPN) shares many similarities with IgA nephropathy. We aimed to analyze the predictive value of the International Study of Kidney Disease in Children (ISKDC) classification and the updated Oxford classification for IgA nephropathy in HSPN patients. For HSP patients, a major factor affecting the long-term outcome is the severity of renal involvement [6], and it has been suggested that some pathologic features may have values in predicting the outcomes of HSPN [7]. Pathologic features of HSPN is usually graded by the International Study of Kidney Disease in Children (ISKDC) classification, mainly according to the existence and the number of crescents [8]. The Oxford classification of IgA nephropathy may be used to group pathologic features of HSPN. We evaluated the utility of both the ISKDC classification and the updated Oxford classification as a predictor of renal outcome by retrospectively reviewing a larger cohort (275 patients, aged≥14 years)followed up in our center
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