Comparison of clinical characteristics of diffused capillary endothelial proliferative Henoch?Schonlein purpura nephritis children with or without crescents formation / 中国综合临床

ABSTRACT

Objective To compare the clinical features of diffuse capillary endothelial proliferative Henoch-Schonlein purpura nephritis ( DEP-HSPN ) with or without crescent formation. Methods The clinical data of 110 children with DEP-HSPN admitted to Dalian Central Hospital and the First Affiliated Hospital of Dalian Medical University from January 2008 to January 2018 were analyzed retrospectively. Among them,24 cases were divided into non crescentic group and 86 cases into crescentic group. The clinical characteristics and prognosis of the two groups were statistically analyzed. Results The clinical manifestations of children without crescent body formation group were all type III. There were 35 cases of type III and 51 cases of type V in the crescent body formation group. Compared with non-crescent formation group,the proportion of gross hematuria(83. 7%(72／86) vs. 29. 2%(7／24),χ2＝10. 396),urine red blood cell count ((112. 4±20. 3)／HP vs. (45. 2±10. 6)／HP,t＝9. 697),24 h urine protein ((2471. 6 ±242. 0) mg／d vs. (1358. 5±109. 3) mg／d,t＝6. 372) and serum creatinine (( 44. 9 ± 9. 6) μmol／L vs. (32. 3±5. 2) μmol／L,t＝5. 390) increased significantly,the serum albumin (( 22. 8±3. 8) g／L vs. ( 35. 1 ±5. 7) g／L,t＝4. 806)decreased significantly (all P＜0. 05). Both groups had non-simple IgA deposits in the mesangial region. The proportion of complete remission and asymptomatic hematuria was 70. 8%( 17／24) and 29. 2%( 7／24) in the non-crescent group, 58. 1%( 50／86) and 41. 9%( 36／86) in the crescent group,respectively,with no significant difference ( χ2＝1. 330,1. 196, all P＞0. 05) . Conclusion When DEP-HSPN is accompanied by crescent formation, gross hematuria, urinary erythrocyte count and the proportion of massive proteinuria increase significantly. Combined immunosuppressive therapy in acute stage and long-term sequential treatment in remission stage can achieve good prognosis.