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Clinicopathological features and prognosis of membranoproliferative-like Henoch-Schönlein purpura nephritis in children

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Abstract

Background

The aim of this retrospective study was to define the clinical manifestations, pathological features and prognosis of children with membranoproliferativelike Henoch-Schönlein purpura nephritis (HSPN), representing International Study of Kidney Disease in Children (ISKDC) grade VI.

Methods

Among 245 patients with HSPN treated in our hospital between 2008 and 2010, nine patients (3.7%) were diagnosed with HSPN of ISKDC grade VI (males=5, females=4, age: 9.5±2.03 years, mean±SD). The clinical features, laboratory and pathological findings, treatment and outcome of the 9 patients were retrospectively analyzed.

Results

Of the 9 patients, 7 (78%) presented with hematuria and nephrotic syndrome, and were treated with steroids (oral prednisone or intravenous methylprednisolone pulse therapy) and immunosuppressants (oral tripterygium glycosides or intravenous cyclophosphamide pulse therapy). One (11%) patient had hematuria and nephrotic range proteinuria (>50 mg/kg per 24 hours) and was treated with oral prednisone and tripterygium glycosides. Another (11%) patient presented with hematuria and moderate proteinuria (25-50 mg/kg per 24 hours) and was treated with oral tripterygium glycoside only. Histopathological examination showed diffuse glomerular mesangial and endocapillary proliferation, mesangial interposition, double-contour formation, podocyte hypertrophy, shedding, and cytoplasmic absorption droplets. The percentages of glomeruli with small cellular crescents varied from 4%-25% in 6 of 9 patients. Follow-up for 2 to 4 years showed excellent recovery in all patients.

Conclusions

The main clinical feature of ISKDC grade VI HSPN in children is a nephrotic syndrome with hematuria. The excellent prognosis of the disease was probably related to early diagnosis and treatment with steroids and/or immunosuppressants, and mild degree of glomerulosclerosis and tubulointerstitial damage.

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Authors and Affiliations

  1. Zhengzhou, China

    Yan-Jie Huang, Xiao-Qing Yang, Wen-Sheng Zhai, Xian-Qing Ren, Qing-Yin Guo, Xia Zhang, Meng Yang, Tatsuo Yamamoto, Yuan Sun & Ying Ding

  2. Department of Pediatrics, First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Beijing, China

    Yan-Jie Huang, Xiao-Qing Yang, Wen-Sheng Zhai, Xian-Qing Ren, Qing-Yin Guo, Xia Zhang, Meng Yang & Ying Ding

  3. Second Department of Medicine, Numazu City Hospital, Numazu, Japan

    Tatsuo Yamamoto

  4. Department of Anesthesia, Stanford University School of Medicine, California, USA

    Yuan Sun

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Correspondence to Yan-Jie Huang.

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Huang, YJ., Yang, XQ., Zhai, WS. et al. Clinicopathological features and prognosis of membranoproliferative-like Henoch-Schönlein purpura nephritis in children. World J Pediatr 11, 338–345 (2015). https://doi.org/10.1007/s12519-014-0527-4

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  • DOI: https://doi.org/10.1007/s12519-014-0527-4

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