Childhood Henoch-Schonlein Nephritis: A Multivariate Analysis of Clinical Features and Renal Morphology at Disease Onset

Abstract

Introduction. Risk factors of renal involvement in Henoch-Schonlein nephritis (HSN) have been extensively studied, but their relations with the severity of glomerular lesions at the disease onset are much less known.

Materials and Methods. Data were collected retrospectively on 45 patients (age range, 2 to 15 years) with HSN to identify the initial clinical and laboratory features that most accurately correlate with histological findings. Nephritic syndrome was defined as hypertension, proteinuria, hematuria, and a creatinine clearance of 60 mL/min/1.73 m² or less. Kidney biopsy findings were graded according to the International Study of Kidney Disease in Children classification for HSN.

Results. Purpura was present in all the 45 children, arthritis in 73.3%, abdominal symptoms with or without bleeding in 68.6%, and a high serum IgA level in 24.4%. Hematuria was present in 88.6% of the patients, hematuria and proteinuria (not in nephrotic range) in 66.7%, nephrotic syndrome in 17.8%, acute nephritic syndrome in 8.9%, and nephritic-nephrotic syndrome in 13.3%. Grades II (33.3%) and III (22.2%) lesions were the most common pathologic findings on kidney biopsy followed by grades IV (17.8%), V (15.6%), and I (11.1%) lesions.  Univariate analysis demonstrated that nephrotic syndrome, acute nephritic syndrome and a creatinine clearance less than 30 mL/min/1.73 m² were all associated with a significantly increased risk of developing grades IV and/or V lesions. multivariate analysis showed nephritic-nephrotic syndrome as significant independent predictors of severity of glomerular disease at onset. 

Conclusions. The severity of renal symptoms at onset determines the intensity of glomerular lesions.