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Multicenter Study
. 2022 Jan;37(1):147-152.
doi: 10.1007/s00467-021-05086-9. Epub 2021 Jul 5.

To biopsy or not to biopsy: Henoch-Schönlein nephritis in children, a 5-year follow-up study

Marina Avramescu  1 , Annie Lahoche  2 , Julien Hogan  3 , Rémi Salomon  1 , Gwenaëlle Roussey  4 , Justine Bacchetta  5 , Stéphane Decramer  6 , Tim Ulinski  7 , Coralie Barbe  8   9 , Christine Pietrement  10
Affiliations
Multicenter Study

To biopsy or not to biopsy: Henoch-Schönlein nephritis in children, a 5-year follow-up study

Marina Avramescu et al. Pediatr Nephrol. 2022 Jan.

Abstract

Background: The prognosis of Henoch-Schönlein purpura (HSP), IgA vasculitis, depends on kidney involvement. There is no consensus on the initiation of treatment for HSP nephritis (HSPN). Some centres start treatment before performing a kidney biopsy (KB) while in others, treatment is dictated by the importance of the clinical, biological and histological signs. The aim of this study was to evaluate which of these two approaches is associated with a better kidney outcome at 5-year follow-up.

Methods: This multicentre, retrospective, nonrandomised study included children treated for HSPN between 2006 and 2010 in a French paediatric nephrology unit. One group had an early KB at diagnosis (before starting treatment or in the 15 following days). In the second group, initial treatment was decided without performing a KB.

Results: Among the 107 children included, 63.5% had an early KB at diagnosis. Follow-up at 5 years was completed in 44 children (28 KB at diagnosis, 16 no KB at diagnosis). Median urine protein/creatinine at 5 years was 2.5 mg/mmol in the early biopsy diagnosis group and 12.5 mg/mmol in the non-biopsy group. An antiproteinuric treatment was given, at 5 years, to 35.7% of the early biopsy at diagnosis children and in 62.5% of the non-biopsied children.

Conclusions: Children with early KB at diagnosis seem to have a better renal outcome at 5 years compared to those without an early biopsy at diagnosis or biopsied later. However, this is a small patient cohort and data are missing. Further work is needed to build consensual guidelines on the management of HSPN in children.

Keywords: Henoch-Schönlein purpura; IgA vasculitis; Kidney biopsy; Nephropathy; Proteinuria.

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