Childhood Henoch-Schonlein nephritis: a multivariate analysis of clinical features and renal morphology at disease onset

Abstract

Introduction: Risk factors of renal involvement in Henoch-Schonlein nephritis (HSN) have been extensively studied, but their relations with the severity of glomerular lesions at the disease onset are much less known.

Materials and methods: Data were collected retrospectively on 45 patients (age range, 2 to 15 years) with HSN to identify the initial clinical and laboratory features that most accurately correlate with histological findings. Nephritic syndrome was defined as hypertension, proteinuria, hematuria, and a creatinine clearance of 60 mL/min/1.73 m2 or less. Kidney biopsy findings were graded according to the International Study of Kidney Disease in Children classification for HSN.

Results: Purpura was present in all the 45 children, arthritis in 73.3%, abdominal symptoms with or without bleeding in 68.6%, and a high serum IgA level in 24.4%. Hematuria was present in 88.6% of the patients, hematuria and proteinuria (not in nephrotic range) in 66.7%, nephrotic syndrome in 17.8%, acute nephritic syndrome in 8.9%, and nephritic-nephrotic syndrome in 13.3%. Grades II (33.3%) and III (22.2%) lesions were the most common pathologic findings on kidney biopsy followed by grades IV (17.8%), V (15.6%), and I (11.1%) lesions. Univariate analysis demonstrated that nephrotic syndrome, acute nephritic syndrome and a creatinine clearance less than 30 mL/min/1.73 m2 were all associated with a significantly increased risk of developing grades IV and/or V lesions. multivariate analysis showed nephritic-nephrotic syndrome as significant independent predictors of severity of glomerular disease at onset.

Conclusions: The severity of renal symptoms at onset determines the intensity of glomerular lesions.