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Comparison of clinical, pathological and long-term renal outcomes of children with Henoch–Schonlein purpura nephritis and IgA nephropathy

  • Nephrology - Original Paper
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Abstract

Purpose

To compare clinical, pathological, and long-term renal outcomes of children with Henoch–Schonlein purpura nephritis (HSPN) and IgA nephropathy (IgAN).

Methods

The medical records of patients diagnosed as HSPN and IgAN during childhood were evaluated retrospectively. HSPN and IgAN groups were compared in terms of gender, age, upper respiratory infection history, blood pressure; presence of nephrotic and/or nephritic syndrome; hemoglobin level, leukocyte count, C-reactive protein (CRP), serum albumin (sAlb), creatinine, complement 3 (sC3), complement 4 (sC4) and immunoglobulin A (sIgA) levels; estimated glomerular filtration rate (eGFR) and proteinuria levels; and renal pathology findings at the onset of disease; total follow-up time; and blood pressure, eGFR and proteinuria levels at the last visit.

Results

Fifty-four patients were enrolled in the study [38 (70%) HSPN and 16 (30%) IgAN]. The median follow-up time was 60.5 and 72.0 months in HSPN and IgAN groups, respectively (p > 0.05). The HSPN and IgAN groups were also not different in terms of gender, age at the onset; leukocyte count, eGFR, sC3-sC4-sIgA levels; and the presence of endocapillary, extracapillary and mesangial proliferation, tubular atrophy, interstitial fibrosis and IgA, IgM, C3 accumulation in renal tissue. Upper respiratory tract infection history was more common in children with IgAN (8/16 vs 8/38, p = 0.045). sAlb (3.96 ± 0.58 vs 4.40 ± 0.46 g/dL, p = 0.005), hemoglobin (12.1 ± 1.3 vs 13.3 ± 1.2 g/dL, p = 0.004,) and the incidence of mesangial IgG deposition (15/38 vs 11/16, p = 0.049) were lower, while CRP (16.3 ± 7.2 vs 7.8 ± 4.4 mg/L, p = 0.002) and proteinuria (72.1 ± 92.4 vs 34.2 ± 37.9 mg/m2/24 h, p = 0.041) was higher in HSPN group at the onset of disease. Proteinuria and eGFR were similar between the two groups at last visit.

Conclusion

Children with HSPN and IgAN have little clinical and histological differences in our population. The most prominent difference at presentation with nephritis was higher proteinuria in HSPN probably associated with inflammation due to systemic vasculitis. Long-term renal outcome was good in both HSPN and IgAN.

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Abbreviations

HSPN:

Henoch–Schonlein purpura nephritis

IgAN:

IgA nephropathy

sAlb:

Serum albumin

sCr:

Serum creatinine

sC3:

Serum complement 3

sC4:

Serum complement 4

sIgA:

Serum immunoglobulin A

eGFR:

Estimated glomerular filtration rate

CR:

Complete remission

PR:

Partial remission

ESR:

Erythrocyte sedimentation rate

CRP:

C-reactive protein

SBP:

Systolic blood pressure

DBP:

Diastolic blood pressure

RAS:

Renin angiotensin system

URTI:

Upper respiratory tract infection

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Authors and Affiliations

  1. Department of Pediatric Nephrology, Medical Faculty, Dokuz Eylül University, Balçova, 35340, Izmir, Turkey

    Meral Torun Bayram, Gizem Yıldız, Alper Soylu & Salih Kavukçu

  2. Departments of Nephrology, Dokuz Eylül University Medical Faculty, Izmir, Turkey

    Cihan Heybeli & Ali Celik

  3. Department of Pathology, Medical Faculty, Dokuz Eylül University, Izmir, Turkey

    Sülen Sarioglu

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  1. Meral Torun Bayram
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Torun Bayram, M., Heybeli, C., Yıldız, G. et al. Comparison of clinical, pathological and long-term renal outcomes of children with Henoch–Schonlein purpura nephritis and IgA nephropathy. Int Urol Nephrol 54, 1925–1932 (2022). https://doi.org/10.1007/s11255-021-03063-7

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