| Background:Henoch-Schonlein purpura nephritis (HSPN) is a common secondary glomerulonephritis in children.The morbility is increase in world.It is reported that 14%-15% HSPN maybe develop end-stage renal failure.Now it is lack of large sample studies and long-term follow up about HSPN in children,and lack of full-scale studies about the clinical,pathological findings and the relationship between them.Objective: To investigate the clinical,pathological findings and their relationship in the HSPN children.Therefore increase the recognition of the disease,and provide reference of the following diagnosis and treatment.To decrease the occurrence of end-stage renal failure and improve the life quality of the patients.Methods: 40 HSPN patients who were admitted in the first pediatric department from the 1st affiliated hospital of Jilin university beween Mar 2007 and Feb 2008 were reviewed.According to the diagnostic criteria which was established by the pediatric department nephrology group of Chinese Medical Association.Retrospective collect and analysis the clinical,pathological data.The clinical classification was based on the criteria established by pediatric department nephrology group of Chinese Medical Association (2000.11. Zhu-Hai).The pathologic classification was based on the criteria established by the International Study of Kidney Diseases in Children (ISKDC).The tubulointerstitial classification system proposed by Bohle and co-workers.They were classified according to different conditions, and to analyse the clinical and pathological data.Results: 1.Clinical characteristics: 23 cases were male, 17 cases were female.at the age of 6 to 14 years.21 cases had obviouse remoting factors, 15 cases (37.5%) was upper respiratory infection.10 cases (47.5%) had no obviouse remoting factors.18 cases (45%) were proteinuria and hematuria in clinical groups. 15 cases (37.5%) were nephritic syndrome.4 cases (10%)were simplified hematuria,1 case(2.5%) was simplified proteinuria.2 cases (5%) were acute nephritis. 19 cases (47.5%) had recurrent rash. 21 cases (52.5%) were complicated with arthralgia. 23 cases (46.5%) were complicated with digestive tract symptoms. 26 cases (60%) had abnormal urinalysis in 1week after the onset of HSP. 12 cases (30%) had abnormal urinalysis in 1week and 3 months after the onset of HSP. 2 cases had abnormal urinalysis after 3 months after the onset of HSP.most children had renal biopsy in 1 month after the abnormal urinalysis (23 cases,57.5%) 2.Pathologic features: The main change was the glomerularpathy,basic damage was different level of hyperplasy of intercapillary cells and the increase of substance, it could be divided into focal and diffuse. Glomerulus could have crescent formation or segmental changes (hardening\ accretion\ thromb\ necrosis).The renal tubule could have different changes (engorgement\ denaturation\ distension\ atrophia) , the interstitial substance could be infiltrated by inf- lammatory cell. According to the standard of ISKDC, most of them were grade II and III, 23 cases (57.5%) were grade II (10 cases were IIa, 13 cases were IIb), 11cases (27.5%) were grade III (4 cases were IIIa, 7 cases were IIIb). 4 cases were grade I, 2 cases were grade IV. The tubulointerstitial classification showed 29 cases (72.5%) were +, 9 cases (22.5%) were ++, 2 cases were +++, no one in ++++. The result showed the percent of deposition of IgA,IgA+IgG,IgA+IgM+IgG was close, which were 10 cases (25%),13 cases (32.5%),12cases (30%), the IgA+IgM deposit was less,it was 5 cases (12.5%). There were 33 cases (82.5%) showed C3 deposit, 15 cases (37.5%) accompanied with Fib deposit, there was little cases showed the deposition of C4 and C1q, each 1 cases. Tubulointerstitial classification,Intensity of IgA deposition,Immuno complex deposition was associated with pathologic classification.C3 deposition was not associated with pathologic classification.3.The relationship between clinic manifestation and pathologic findings: The gender, abdominal symptoms, the duration from onset of HSP to abnormal urinalysis were not associated with pathologic classification, recurrence of skin rashes was associated with pathologic classification.Clinical type was associated with pathologic classification , severe clinical type showed severe pathologic classification.Serum IgA level and C3 level were not related to pathologic classification (P>0.05). 4.All patients were followed-up,5 cases (100%) of hematuria/ proteinuria were A, 16 cases (88.9%) in hematuria and proteinuria were A, Clinical type was associated with prognosis (P<0.01). The outcome of pathologic classification typeâ… were all A, 20 cases (86.9%) of typeâ…¡were A, 5 cases (38.4%) of typeâ…¢-â…£were A, pathologic classification was associated with prognosis (P<0.01).Tubulointerstitial classification showed 23 cases(79.3%) were A in type +, 6 cases (54.5%) in type ++/+++ were A, 3 cases (27.3%) were B, 2 cases (18.2%) were C. Tubulointerstitial classification was associated with prognosis (P<0.05).Conclusion: 1. The HSPN patients mainly showed the type of hematuria and proteinuria,nephrotic syndrome. 95% cases showed abnormal urinalysis in 3 months. 2.The HSPN patients mainly showed mesenterium hyperplasy in pathological lesion. The more severe of the tubulointerstitial classification,intensity of IgA and immunopathogenesis ,the more severe of the renal pathological lesion.3. Clinical classification was associated with pathologic classification, the more severe of the clinical classification showed the more severe of renal damage. 4. Clinical classification,pathologic classification,tubulointerstitial classification were associated with prognosis. 5.The promptly renal biopsy should be done in suitable HSPN patients, understand the clinic and pathologic classification, using proply therapy, to improve the prognosis.
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