Clinical And Pathological Analysis Of 72 Cases With Henoch-Schonlein Purpura Nephritis In Adults

Objective: 1. To analyze the clinical and pathological data of adult patients with HenochSchonlein purpura nephritis in the First Hospital of Jilin University, and summary the law of the onset of the disease, clinical characteristics, treatment methods, in order to provide the foundation for the diagnosis, the illness judgment and treatment of the disease.2. To analyze the data of adult patients who had Henoch-Schonlein purpura nephritis by renal biopsy, and summary the clinical pathological characteristics and their correlations, in order to look for factors influencing prognosis, provide the foundation for the diagnosis, treatment and improving the clinical manifestation and prognosis.Materials and Methods: 1. The data of 72 HSPN patients who were diagnosed in the first hospital of Jilin University from January 2009 to October 2015 were collected, and excluded those who were younger than 16 years of age or older than 60 years. All the HSPN patients have complete clinical and laboratory data, and the data were analyzed by SPSS 23.0.2. Half of the 72 HSPN patients in adults had renal biopsy, and their clinical stages were all less than CKD3. They were assessed using ISKDC grading system and Katafuchi semi-quantitative score by observing their clinical and laboratory indexes. The correlational analysis between tubulointerstitial score and glomerular lesions were conducted by Pearson correlation analysis. Multiple sets of measurement data used analysis of variance, and calculators information used chi-square test. P < 0.05 showed the difference was statistically significant.Result: 1. 72 cases of adult patients with Henoch-Schonlein purpura include male 39(54%) and female 33(46%) and there was no significant gender difference in sexuality. The average age was 32.0 ± 13.1 years old, and The number age group between 16~39 were multiple,compared with the rest of 40~59 age group(P < 0.01).2. All patients had purpura rash in the course of the disease, including 13 cases of abdominal symptoms and arthritis, accounting for 18%. The high peak was in spring and summer, with 21 and 20 cases respectively. There was a clear allergy for 25 cases of patients, accounting for 35%, including 12 cases of drug allergy, the rest of the seafood, eggs, meat, beans, celery, metal, etc. In 12 cases of drug allergy, 7 cases of penicillin was the most common, the rest of the azithromycin, cephalosporins, etc.3. In this study, 46 cases(63.9%) reported with normal blood pressure and the constituent ratio was high with significant differences(P<0.05). During the 7 cases(9.7%) reported with grade Ⅲhypertension, diastolic blood pressure increased more than systolic blood pressure. The mild-to-moderate proteinuria was in the majority when considering the level of proteinuria. Half of the patients hadn’t normal level of glomerular filtration rate(e GFR,calculated by MDRD equation).4. 36 HSPN patients who had renal biopsy were calssed by ISKDC. The type renal Ⅲpathological changes were reported with 27 cases, accounting for 75%; 4 cases(11%) were with type Ⅱ, 4 cases(11%) were with type and only one patient had type pathological Ⅱ Ⅱchanges.5. In the 36 patients, the correlation coefficient between tubulointerstitial score and glomerular active score was 0.252(P > 0.05); the correlation coefficient between tubulointerstitial score and glomerular chronic score was 0.544(P<0.01). There was excellent correlations between tubulointerstitial lesions and glomerular chronic lesions.6. The higher pathological grade, the higher the glomerulor chronic lesions(P<0.05); tubulointerstitial lesions and glomerulor active lesions did not rise significantly(P>0.05).7. As patients’ daily urine protein quantitative increased, compared with patiens of mild proteinuria, patients of moderate proteinuria glomerular active lesions and glomerular chronic integral increased significantly, while tubulointerstitial lesions did not rise significantly. As the glomerular filtration rate decreased, compared with CKD2 period, CKD3 period glomerular chronic lesions and tubulointerstitial lesions rise significantly while glomerular active lesions did not rise significantly. There was no significant correlation between blood pressure and glomerular pathological changes.Conclusion: 1. The adult patients with Henoch- Schonlein purpura nephritis was easily occured in the young people whose age were between 16~39. About a third of them presented with allergy, especially drug allergy.2. The mild-to-moderate proteinuria is in the majority. About half of the 72 patients glomerular filtration rate decreased. Less than half of the patients’ blood pressure rose. Among the 7 patients with grade Ⅲ,diastolic blood pressure increased more than systolic blood pressure.3. In the 36 patients, the mainly ISKDC pathologic stage was type Ⅲ. There was excellent correlations between tubulointerstitial lesions and glomerular chronic lesions.4. Compared with group mild proteinuria, group moderate proteinuria glomerular active lesions and glomerular chronic integral increased significantly. As the glomerular filtration rate decreased, glomerular chronic lesions and tubulointerstitial lesions rise significantly while glomerular active lesions did not rise significantly.