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Meta-Analysis
. 2019 Oct 1;14(10):e0223218.
doi: 10.1371/journal.pone.0223218. eCollection 2019.

Risk factors associated with IgA vasculitis with nephritis (Henoch-Schönlein purpura nephritis) progressing to unfavorable outcomes: A meta-analysis

Dongmei Shi  1   2   3 , Han Chan  1   2 , Xia Yang  3 , Gaofu Zhang  1   2 , Haiping Yang  1   2 , Mo Wang  1   2 , Qiu Li  1   2
Affiliations
Meta-Analysis

Risk factors associated with IgA vasculitis with nephritis (Henoch-Schönlein purpura nephritis) progressing to unfavorable outcomes: A meta-analysis

Dongmei Shi et al. PLoS One. .

Abstract

Objective: To identify risk factors associated with unfavorable outcomes in children with IgA vasculitis with nephritis (Henoch-Schőnlein purpura nephritis)(IgA-VN).

Methods: PubMed, Embase, and Web of Science databases were searched for studies, published in English through February 2019. The data were extracted to perform pooled analysis, heterogeneity testing, subgroup analysis, sensitivity analysis, and publication bias analysis.

Results: This meta-analysis showed that, older age at onset (WMD 1.77, 95% CI 0.35-3.18, p = 0.014), lower glomerular filtration rate (GFR; WMD -23.93, 95% CI -33.78- -14.09, p<0.0001), initial renal manifestations with nephrotic syndrome (OR 1.74, 95% CI 1.12-2.70, p = 0.013), with nephritic-nephrotic syndrome (OR 4.55, 95% CI 2.89-7.15, p<0.0001) and renal biopsy with crescentic nephritis (International Study of Kidney Disease in Children [ISKDC] grades III-V) (OR 3.85, 95% CI 2.37-6.28, p<0.0001) were significant risk factors associated with poor outcomes in IgA-VN, whereas initial clinical features with hematuria (OR 0.33, 95% CI 0.16-0.69, p = 0.003) and mild proteinuria±hematuria (OR 0.46, 95% CI 0.28-0.75, p<0.0001) were associated with progression to good outcomes. By contrast, gender, hypertension and initial renal manifestations of acute nephritic syndrome were not significantly associated with poor outcomes in IgA-VN.

Conclusion: This meta-analysis showed that older age at onset, lower GFR, initial renal features of nephrotic syndrome and nephritic-nephrotic syndrome and renal biopsy with crescentic nephritis (ISKDC grades III-V) were predictive of poor prognosis in children with IgA-VN.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart of selection process for eligible studies.
Fig 2
Fig 2. Forest plots of OR/WMD estimates for the following.
(A) age. (B) gender (male vs. female). (C) hypertension. (D) level of GFR.
Fig 3
Fig 3. Forest plots of OR estimates for initial clinical features: hematuria, mild proteinuria±hematuria, acute nephritic syndrome, nephrotic syndrome, and nephritic-nephrotic syndrome.
Fig 4
Fig 4. Forest plots of OR estimates for initial renal biopsy: Crescentic nephritis (ISKDC grades III-V).
Fig 5
Fig 5. Subgroup analysis of in renal features with nephrotic syndrome.
(A) follow-up duration. (B) ethnicity. (C)date of publication. (D) study quality.
Fig 6
Fig 6. Subgroup analysis of in initial renal biopsy with crescentic nephritis (ISKDC grades III-V).
(A) follow-up duration. (B) ethnicity. (C) date of publication. (D) study quality. Sensitivity analysis showed that no individual study significantly altered the effects of nephrotic syndrome, nephritic-nephrotic syndrome and initial renal biopsy with crescentic nephritis on patient prognosis (Fig 7).
Fig 7
Fig 7. Sensitivity analysis.
(A) nephrotic syndrome. (B) nephritic-nephrotic syndrome. (C) initial renal biopsy with crescentic nephritison.
See this image and copyright information in PMC

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