Analysis of clinical manifestations and pathological findings in children with massive proteinuria with Henoch-Schonlein purpura nephritis / 中华儿科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To evaluate clinical manifestations and pathology in children with massive proteinuria with Henoch-Schonlein purpura nephritis (HSPN).</p><p><b>METHOD</b>The data of the 52 children with massive proteinuria with Henoch-Schonlein purpura nephritis who were hospitalized in the department of nephrology in our hospital from January 2008 to January 2013 were retrospectively studied. Clinical manifestation and pathologic characteristics were summarized and compared. The relationship between clinical manifestations and pathologic characteristics were evaluated.</p><p><b>RESULT</b>(1) Among the children, 16 (31%) cases had positive symptoms and signs including gross hematuria, edema, oliguria and hypertension, and in only 7 (13%) cases serum levels of albumin were below 25 g/L. (2) Children with pathological grade >III accounted for 72%. Children with crescent formation, glomerular capsule adhesion, segmental glomeralosclerosis, endocapillary proliferation and lesions in the walls of arterioles accounted for 56%, 52%, 19%, 67%, 62%, respectively, and 42% of the children suffered from severe mesangial proliferation or mesangial sclerosis. The frequencies of severe mesangial proliferation and changes in the walls of arterioles in children with pathological grade ≥ III was significantly higher than those in children with pathological grade <III (χ(2)=10.971, P=0.001; χ(2)=4.132, P=0.042). (3) The relationship between clinical manifestation and pathologic characteristics The number of crescents was positively correlated with 24-hour urinary protein quantity in children with crescent formation. The frequencies of segmental glomeralosclerosis and endocapillary proliferation of the children with clinical symptoms including gross hematuria, hypertension, renal dysfunction or decreased complement C3 were significantly higher than those of children without clinical symptoms (χ(2)=19.69, P=0.00; χ(2)=3.887, P=0.049).</p><p><b>CONCLUSION</b>The clinical manifestations of children with massive proteinuria with HSPN were relatively severe but the symptoms were not typical. The pathological manifestations wer variable, of which severe mesangial proliferation and lesions in arterioles are the most common in children with higher pathological grade. Clinical manifestations in children with HSPN are associated with formation of crescent, segmental glomeralosclerosis, glomerular capsule adhesion, and endocapillary proliferation.</p>