Abstract:

Objective To explore independent risk factors for poor renal outcome defined as an estimated glomerular filtration rate (eGFR)<90 mL/(min·1.73m²) in children with Henoch-Schönlein purpura nephritis (HSPN). Methods The clinical data of children diagnosed with HSPN after completing renal biopsy from January 2000 to December 2019 were retrospectively analyzed, and the independent risk factors leading to poor renal prognosis were analyzed by multivariate logistic regression. Results A total of 476 children with HSPN were included, of whom 31(6.5%) had poor renal outcomes. There were 278 boys and 198 girls, and the age of onset was 10.7 (8.1-13.2) years. The median follow-up time was 33.8 (20.9-54.2) months. Compared with the good prognosis group, the poor prognosis group had older age of onset, longer time from renal involvement to renal aspiration, higher proportions of high uric acid, high cholesterol, eGFR<90 mL/(min·1.73m²), large albuminuria and high urinary retinol binding protein (RBP), and the differences were statistically significant (P<0.05). There were significant differences in segmental glomerulosclerosis/adhesion, >25% renal tubular atrophy/interstitial fibrosis, and the degree of crescent formation between the good and poor prognosis groups (P<0.05). Multivariate logistic regression analysis showed that segmental glomerulosclerosis/adhesion, >25% renal tubular atrophy/interstitial fibrosis and high urinary RBP were independent risk factors for poor renal prognosis (P<0.05). Conclusions This study found three risk factors for poor renal prognosis in children with HSPN, which are worthy of further clinical exploration and verification.

Key words: Henoch-Schönlein purpura nephritis, IgA vasculitis, crescent, child