| Background Henoch-Schonlein Purpura nephritis(HSPN)develop in HSP patients who have renal involvement,the renal involvement is the most important factor conditioning prognosis of HSP.Epidemiological surveys showed that HSPN incidence increased gradually in recent years.Research showed that protein in the urine was not only a sign of renal involvement,but also was a key factor contributing to renal disease progression and prognosis,A nephrotic state at disease onset has been proposed as a predictor of poor renal outcomes.Study on nephrotic range proteinuria of Henoch-Sch?nlein Purpura Nephritis was essential,but there was still a lack of large sample study on clinical features and prognosis of HSPN with nephrotic range proteinuria.The survey aims to analyze the clinical features and predictors of outcome of Henoch-Schonlein Purpura nephritis with nephrotic range proteinuria in children who in our hospital.Objectives TO implement a restospective analysis of HSPN with nephrotic range proteinuria phenotypes such as clinical features,biopsy findings and prognosis,with the purpose to obtain the currently available evidence on the efficacy of treatment options.Methods A restrospective analysis of 137 HSPN patients in Shanghai children’s Hospital from January 2009 to December 2013 was implements.The chidren were divided into nephrotic range proteinuria group and nonnephrotic range proteinuria group according to 24–hour urinary protein quantity and analyze groups for gender,age,clinical features,pathology,treatment and prognosis.Results 1.General information.The study group consisted of 137 children,80 boys and 40 girls,with the ratio of boys to girls to be 1.40:1.The mean age was 8.49 ± 2.93 years.NP group had 57 children,34 boys and 20 girls,the mean age was8.39± 2.85 years.NNP group had 83 children,46 boys and 37 girls,the mean age was 9.21 ± 2.94 years.there is no statistically significant difference comparing.2.Clinical features.NP group with joint symptoms in 8 cases(14.81%),gastrointestinal symptoms 9 cases(16.67%),NNP group of children with symptoms of joint 10 cases(12.04%),digestive tract symptoms in 12 cases(14.46%),clinical signs and symptoms associated with no statistical relationship between the two groups(P>0.05).Analysis of laboratory test,the results are shown in table that albumin,BUN,Cys-C,Ig G are the risk factors to renal involvement(P<0.05).3.Pathological feature.The majority of pathological changes of NP group were above grade Ⅲ(62.97%).NP group and NNP group pathological below grading Ⅲ were 37.04% and 62.65% respectively.Renal damage of tubulointerstitium differences between the two groups was statistically significant(P < 0.01),NP group of renal tubule interstitial damage is given priority to with + + level and above.Immune complex deposition in NP group were dominated by Ig A,immune complex deposition type and whether associated with C3 deposition are no significant difference of urinary protein excretion(P>0.05).4.Prognostic features.The prognosis of both NP group and NNP group are in complete remission(a level),and no development of ESRD,the difference was not statistically significant(P>0.05).The prognosis of purpura nephritis is associated with clinical classification,pathologic stage(P<0.01 or P<0.05).At the same time,the higher the urine protein、BUN、Scr、Cys-c、Ig A、TT,the lower of e GFR,the worse prognosis.In treatment,NP group and the treatment of NNP group difference was statistically significant(P<0.05).But NP group there was no statistical difference each treatment selection and prognostic significance(P>0.05).NNP group choose different treatment and prognosis of difference was statistically significant(P<0.05).Conclusion Nephrotic range proteinuria of Henoch-Schonlein Purpura nephritis has its own characteristics,biopsy findings are mainly Ⅲ class above.albumin,blood urea nitrogen,cystatin C,Ig G can be used as early detection;through timely and early optimistic prognosis after treatment. |
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