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A clinicopathological comparison between IgA nephropathy and Henoch–Schönlein purpura nephritis in children: use of the Oxford classification

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Abstract

Background

There is controversy over whether IgA nephropathy (IgAN) and Henoch–Schönlein purpura nephritis (HSPN) are the same diseases. This study focuses on the clinicopathological comparison between HSPN and IgAN in children.

Methods

Children with IgAN and HSPN who had a diagnostic renal biopsy were enrolled. This study collected the clinical data of patients at biopsy, re-evaluated the pathological lesions of patients according to the Oxford Classification (MEST-C), and made a retrospective comparison between IgAN and HSPN on different stratifications of the course (Tc) and proteinuria.

Results

A total of 142 children with IgAN and 57 children with HSPN were enrolled. Various stratification showed the same result, which suggested that IgAN showed more mesangial proliferation (M). HSPN showed more segmental glomerulosclerosis in the Tc > 12 m group than IgAN (S 60.0% vs. 9.10%, P = 0.008). In the non-nephrotic-range and nephrotic-range proteinuria group, there were no significant differences in MEST-C scores between IgAN and HSPN.

Conclusion

M is more common in IgAN. HSPN had more S than IgAN over the course of more than 12 months. These results indicate the differences in the pathogenesis in IgAN and HSPN. We propose early biopsy and active treatment of HSPN within 12 months to delay the development of chronic lesions.

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Acknowledgements

We thank all our colleagues at the Department of Nephrology, Beijing Children's Hospital, China for providing the pediatric patient case information, Dr. Nan Zhang and Dr. Xingfeng Yao of the Department of Pathology, Beijing Children's Hospital, China for advice regarding renal pathology, and Dr. Lin Hua of the School of Biomedical Engineering, Capital Medical University, China for providing help with the statistical analysis.

Funding

This work was supported by the Capital Health Research and Development of Special Grant (No. 2016-2-2094), the Research on the Application of Capital Clinical Characteristics Program of Beijing Municipal Science and Technology Commission (No. Z161100000516106) and the Project of Beijing Science and Technology Commission (No. D181100000118006).

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Authors and Affiliations

  1. Department of Nephrology, Beijing Children’s Hospital, Capital Medical University, Beijing, 100045, China

    Xueqian Li, Mengmeng Tang, Jianfeng Fan, Nan Zhou, Qiang Sun, Zhi Chen, Qun Meng, Lei Lei, Hejia Zhang, Chen Ling & Xiaorong Liu

  2. Beijing Children’s Hemodialysis Center, Beijing, 100045, China

    Xueqian Li, Mengmeng Tang, Jianfeng Fan, Nan Zhou, Qiang Sun, Zhi Chen, Qun Meng, Lei Lei, Hejia Zhang, Chen Ling & Xiaorong Liu

  3. Beijing Key Laboratory of Pediatric Chronic Kidney Disease and Blood Purification, Beijing Children’s Hospital, Capital Medical University, Beijing, 100045, China

    Xueqian Li, Mengmeng Tang, Jianfeng Fan, Nan Zhou, Qiang Sun, Zhi Chen, Qun Meng, Lei Lei, Hejia Zhang, Chen Ling & Xiaorong Liu

  4. National Center for Children’s Health, Beijing, 100045, China

    Xueqian Li, Mengmeng Tang, Xingfeng Yao, Nan Zhang, Jianfeng Fan, Nan Zhou, Qiang Sun, Zhi Chen, Qun Meng, Lei Lei, Hejia Zhang, Chen Ling & Xiaorong Liu

  5. Department of Pathology, Beijing Children’s Hospital, Capital Medical University, Beijing, 100045, China

    Xingfeng Yao & Nan Zhang

  6. Biostatistics and Bioinformatics, School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China

    Lin Hua

  7. Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, 28th Fuxing Road, Beijing, 100853, China

    Xiangmei Chen

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  1. Xueqian Li
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Correspondence to Xiaorong Liu.

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The study was approved by the ethics committee of Beijing Children’s Hospital, China. The Ethics Committee specifically stated that informed consent was not required because this study was retrospective and the data analyzed anonymously.

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Li, X., Tang, M., Yao, X. et al. A clinicopathological comparison between IgA nephropathy and Henoch–Schönlein purpura nephritis in children: use of the Oxford classification. Clin Exp Nephrol 23, 1382–1390 (2019). https://doi.org/10.1007/s10157-019-01777-8

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