Childhood Henoch-Schonlein nephritis: a multivariate analysis of clinical features and renal morphology at disease onset

ABSTRACT

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. 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 m[2] or less. Kidney biopsy findings were graded according to the International Study of Kidney Disease in Children classification for HSN. 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