The ISKDC classification and a new semiquantitative classification for predicting outcomes of Henoch–Schönlein purpura nephritis
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Histological findings from primary kidney biopsies were correlated with patient outcomes in a national cohort of paediatric Henoch–Schönlein nephritis (HSN) patients.
Primary kidney biopsies from 53 HSN patients were re-evaluated using the ISKDC (International Study of Kidney Disease in Children) classification and a modified semiquantitative classification (SQC) that scores renal findings and also takes into account activity, chronicity and tubulointerstitial indices. The ISKDC and SQC classifications were evaluated comparatively in four outcome groups: no signs of renal disease (outcome A, n = 27), minor urinary abnormalities (outcome B, n = 18), active renal disease (outcome C, n = 3) and renal insufficiency, end-stage renal disease or succumbed due to HSN (outcome D, n = 5). For the receiver operating characteristic and logistic regression analyses, outcomes A and B were considered to be favourable and outcomes C and D to be unfavourable. The median follow-up time was 7.3 years.
The patients with an unfavourable outcome (C and D), considered together due to low patient numbers, had significantly higher total biopsy SQC scores and activity indices than those who had a favourable one (groups A and B). The chronicity and tubulointerstitial indices differed significantly only between group C + D and group A. The difference in areas under the curve between the total biopsy SQC scores and ISKDC findings was 0.15 [p = 0.04, normal-based 95% confidence interval (CI) 0.007–0.29, bias-controlled 95% CI −0.004 to 0.28].
Our results suggest that the modified SQC is more sensitive than ISKDC classification for predicting the outcome in HSN cases.
KeywordsChildren Glomerulonephritis Histology Renal biopsy Semiquantitative Vasculitis
The authors wish to thank Jesper Kivelä and Mitja Lääperi for assistance in the statistical analyses.
Compliance with ethical standards
This work was supported by a grant to M.K. from the Alma and K.A. Snellman Foundation, Oulu, Finland and from the Foundation of Paediatric Research and salary to M.K. from Competitive State Research Financing of the Expert Responsibility area of Oulu University Hospital.
Conflict of interest
The authors declare that they have no conflict of interest.
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