Relation Between Chinese Medicine Syndrome Pattern And Renal Pathology Or Podocalyxin In Urine About Children Suffering From Henoch-Schonlein Purpura Nephritis

OBJECTIVES:To draw off index correlated with Henoch-Schonlein Purpura Nephritis (HSPN) on traditional Chinese medicine (TCM). TCM syndromes of HSPN were approached in children. The relationship between TCM syndromes and clinical characteristic, grade in pathology, immunofluorescence types, glomerular podocyte injury, and urinary excretion of podocalyxin was analyzed in children with HSPN.METHODS:A prospective study on126children suffering from HSPN was carried out during the period of1st January2010to1st September2011in pediatrics department of Nanjing command of jingling hospital. Differentiation of symptoms and signs on TCM were procured after investigating pertinent documents. In order to evaluate TCM syndromes in every child, the cluster analysis and univariate analysis were progressed on the index about TCM in126HSPN cases. Renal pathology and urinary excretion of podocalyxin was detected in72children. From conventional pathologic examination, the pathology grade and immunofluorescence types in children were ascertained. According to the degree on fusion of foot process, podocyte injury in glomerulurn was observed and classified on electron microscope. The relationship was analyzed between TCM syndromes and clinical characteristic, grade in pathology, urinary excretion of podocalyxin.RESULTS:In the study reported here,126children were included. TCM syndromes were classified as the syndrome of wind-heat hurting collaterals in42(33.3%), the syndrome of heat in blood to interfere kidney in39(31%),the syndrome of kidney-YIN insufficiency in34(27%)and the syndrome of deficiency of both vital energy and yin in11(8.7%). Pathological findings were classified as ISKDC grade II in34(47.2%) and grade â…¢ in38(52.8%).The renal immunofluorescence pathology was compatible with IgA type in13(18.1%), IgA+G type in31(43.1%), IgA+M type in6(8.3%),IgA+M+G type in22(30.6%). Glomerular podocyte injury was classified by electron microscope as food processes of podocyte fused extensively in21cases; food processes of podocyte fused segmental in35cases, food processes of podocyte without fusion in11cases.There was without renal glamorous in nephridial tissue by electron microscope on five cases. Children with the syndrome of kidney-YIN insufficiency, whose course of disease exceeding one month,were more than those with the syndrome of wind-heat hurting collaterals(P<0.05). Children with the syndrome of deficiency of both vital energy and yin, whose course of disease exceeding one month,were more than those with the syndrome of wind-heat hurting collaterals and heat in blood to interfere kidney (P<0.05). There was no statistically significant difference between every TCM syndrome and age or gender in those children (P>0.05). In the syndrome of wind-heat hurting collaterals, there were more children combined with infection ahead than other syndromes (P<0.05).Children with the syndrome of wind-heat hurting collaterals and kidney-YIN insufficiency manifested mostly as hematuria and albuminuria in clinic (P<0.05). Furthermore, children with the syndrome of deficiency of both vital energy and yin manifested mostly as nephrotic syndrome (P<0.05). In the study,the grade â…¡ was the most common pathological type in children with the syndrome of heat in blood to interfere kidney, but the grade â…¢ was mostly common in the syndrome of kidney-YIN insufficiency(P<0.05). The pathological type in cases with sthenia syndrome was grade â…¡ mostly, but the type in majority cases with asthenia syndrome was grade â…¢(P<0.05). The renal immunofluorescence pathology was mostly IgA+G type in the syndrome of wind-heat hurting collaterals, and IgA+M+G type was frequent in the syndrome of kidney-YIN insufficiency(P<0.05). Foot process of podocyte was mostly fused segmental in children with the syndrome of wind-heat hurting collaterals and heat in blood to interfere kidney. In children with the syndrome of kidney-YIN insufficiency and deficiency of both vital energy and yin, foot process of podocyte was mostly fused extensively, children with foot process of podocyte fused extensively were more grade â…¢ than those cases with foot process fused segmental and without fusion. The value of urinary podocalyxin in children with the syndrome of wind-heat hurting collaterals and heat in blood to interfere kidney was lower than in those with kidney-YIN insufficiency and deficiency of both vital energy and yin. The value of urinary podocalyxin in children with isolated albuminuria was higher than those with isolated hematuria and lower than those with nephrotic syndrome (P<0.05).In children with histological grade â…¢, the value of urinary podocalyxin was higher than grade â…¡(P<0.05).CONCLUSIONS:Following with protraction in history and progression of disease, TCM syndromes in children with HSPN made advancement from wind-heat hurting collaterals and heat in blood to interfere kidney to kidney-YIN insufficiency and deficiency of both vital energy and yin. From different TCM syndromes, there was discrepancy in clinical manifestation. The pathological alteration in cases with asthenia syndrome was serious than those with sthenia syndrome. Compared with sthenia syndrome, the type of immunoglobulin deposited in renal glomerulus was more than in children with asthenia syndrome. Following with the progress on TCM syndromes, the degree of glomerular podocyte injury aggravated, expressed with foot process of podocytes fused more extensively on electron microscope and the value of urinary podocalyxin advanced. More seriously on the degree of podocyte injury, more obviously in pathologic change.