Immunoglobulin A Vasculitis Nephritis in Children: Experience from a Tertiary Care Hospital, Bangladesh
Journal of Pediatric Nephrology,
Vol. 9 No. 1 (2021),
3 January 2021
,
Page 1-7
https://doi.org/10.22037/jpn.v9i1.32651
Abstract
Background and Aim: Immunoglobulin A vasculitis (IgAV), formerly known as Henoch-Schönlein purpura (HSP),is the most common vasculitis in children with multiorgan involvement. Renal involvement is one of the important causes of morbidity and mortality. The objective of this study was to evaluate the frequency, clinical profile, and outcome of IgA vasculitis nephritis (IgAVN) in children.
Methods:This prospective cross-sectional study was conducted in Dr. MRKhan Children Hospital & Institute of Child Health, Dhaka, over a period of 5years from January 2015 to December 2019. Data were collected using a structured questionnaire form and analyzed by the SPSS software version 20.0.
Results:A total of 57cases of IgA vasculitis were admitted of whom 16 (28%) had renal involvement. The mean age was 7.7years. Regarding renal involvement, the majority of the patients (56.25%) had isolated hematuria. All nephritis patients (100%) had purpura and 75% of the patients had severe abdominal pain. The mean hematocrit and the mean platelet count were significantly higher in the nephritis group compared to patients without nephritis (41.49±4.47vs.39.98±5.16, p-value<0.005 and485.51±58.29 vs. 293.89±65.15, p-value<0.001, respectively). The level of complement C3 was significantly lower in the nephritis group compared to patients without nephritis (0.85±0.4 vs. 1.5±0.3, p-value <0.01). The majority (68.75%) of the patients recovered and 18.75% were in remission with immunosuppressant. None of the cases progressed to ESRD.
Conclusion:Severe abdominal pain, high platelet counts, high hematocrit levels, and low C3 concentrations are common findings in nephritis. Nephritis resolvespontaneously in most cases but severe nephritis requires treatment with immunosuppressive drugs for remission.
- Immunoglobulin A vasculitis
- Nephritis
- Vasculitis
- Child
How to Cite
References
2. Feng D, Huang WY, Hao NXL, Wang P, Wu Y, et al. A single-center analysis of Henoch-Schonlein purpura nephritis with nephrotic proteinuria in children. Pediatr Rheumatol Online J. 2017;15:15.
3. Jannette JC, Falk RJ, et al. 2012 Revised International Chapel Hill Con¬sensus Conference of Nomenclature of Vasculitides. Arthritis Rheum. 2013;65(1):1–11.
4. Gardner Medwin JM, Dolezalova P, Cummins C, Southwood TR. Incidence of Henoch-Schonlein purpura, Kawasaki disease, and rare vasculitides in children of different ethnic origins.Lancet. 2002; 360 (9341):1197±1202. doi: 10.1016/S0140-6736(02)11279-7 PMID: 12401245
5. Anup Rai, Cynthia Nast, and Sharon Adler. Henoch-Scho¨nlein Purpura Nephritis. J Am Soc Nephrol.1999;10: 2637–2644.
6. Gardner-Medwin JM, Dolezalova P, Cummins C, Southwood TR. Incidence of Henoch-Schönlein purpura, Kawasaki disease, and rare vasculitides in children of different ethnic origins. Lancet 2002;360:1197-1202.
7. Keith K. Lau. Hitoshi Suzuki. Jan Novak. Robert J Wyatt. Pathogenesis of Henoch-Schönlein Purpura Nephritis.Pediatr nephrol 2010; 25:19-26.
8. Pillebout E, Jamin A, Ayari H, Housset P, Pierre M, Sauvaget V, et al. Biomarkers of IgA vasculitis nephritis in children. PLoS One 2017;12:e0188718.
9. Ekinci RMK, Balci S, Melek E, et al. Clinical manifestations and outcomes of 420 children with Henoch Schönlein Purpura from a single referral center from Turkey: A three-year experience [published online ahead of print, 2019 Nov 14]. Mod Rheumatol. 2019;1-8. doi:10.1080/14397595.2019.1687074
10. Goldstein AR, White RH, Akuse R, et al. Long-term follow-up of childhood Henoch-Schonlein nephritis. Lancet 1992;339:280–282.
11. H Narchi. Risk of long term renal impairment and duration of follow up recommended for Henoch-Schonlein purpura with normal or minimal urinary findings: A systemic review. Arch Dis Child 2005;90:916–920. doi: 10.1136/adc.2005.074641
12. Stewart M, Savage JM, Bell B, McCord B.Long term renal prognosis of Henoch-Schonlein purpura in an unselected childhood population.Eur J Pediatr.1988; 147:113±115. PMID: 3366130
13. Ozen S1, Pistorio A, Iusan SM, Bakkaloglu A, Herlin T, Brik R, et al. Paediatric Rheumatology International Trials Organisation (PRINTO). EULAR/PRINTO/PRES criteria for Henoch-Schonlein purpura, childhood polyarteritis nodosa, childhood Wegenergranulomatosis, and childhood Takayasu arteritis: Ankara 2008. Part II: Final classification criteria. Ann Rheum Dis 2010;69:798- 806.
14. Dan Feng, Wen-Yan Huang*, Sheng Hao, Xiao-Ling Niu. A single-center analysis of Henoch-Schonlein purpura nephritis with nephrotic proteinuria in children.
Pediatric Rheumatology (2017) 15:15 DOI 10.1186/s12969-017-0146-4
15. Naija O, Bouzaraa J, Goucha-Louzir R, Gargah T. Henoch Schönlein nephritis
in children: clinical features and outcome: about 34 cases. TunisMed. 2013;
91(12):700–4.
16. Pohl M. Henoch–Schönlein purpura nephritis. Pediatr Nephrol. 2015; 30(2):245–252
17. Katarzyna Dyga, Maria Szczepańska. IgA vasculitis and nephritis in children.
Adv Clin Exp Med. 2020;29(4):513–519
18. Vânia Schinzel, Jade Dib F, Gleice C, Melissa M, Maria A, Claudio A L, and Maria T. The profile and clinical outcomes of patients with renal involvement due to IgA vasculitis: is azathioprine a good option for treatment? Advances in Rheumatology. (2019) 59:21 https://doi.org/10.1186/s42358-019-0064-x
19. Jauhola O, Ronkainen J, Koskimies O, Ala-Houhala M, Arikoski P, HoÈ lttaÈ T. Renal manifestations of Henoch-SchoÈnlein purpura in a 6-month prospective study of 223 children.Arch Dis Child.2010; 95 (11):877±882. doi: 10.1136/adc.2009.182394 PMID: 2085
20. G Muinuddin, A Begum. Henoch-Schönlein purpura nephritis in children: A Review. Bangladesh J Child Health 2014; VOL 38 (1) : 24-31
21. 21. Zhu J-J, Yi Z-W, Huang I-H, Long I, Chen I.Clinical analysis of 118 cases of Henoch Schonlein purpura nephritis in children. J Clin Dermatol.2014; 43(6):336±339.
22. David T. S, Josephine M. A, Gerald B. A, Andrew S. B, Raed Bou M. Clinical Characteristics and Treatment Patterns of Children and Adults With IgA Nephropathy or IgA Vasculitis: Findings From the CureGN Study. Kidney International Reports (2018) 3, 1373–1384.
23. Davin JC, Coppo R. Henoch-Schonlein purpura nephritis in children. Nat Rev Nephrol. 2014;10:563–573.
24. Mao Song, Zhang Jianhua. Risk factors for renal damage in Henoch-Schonlein purpura: a meta-analysis. Int J Clin Exp Med 2016; 9(2):3607±3613.Available at: http://ijcem.com/files/ijcem0016518.pdf
25. Chan H, Tang Y-L, Lv X-H, Zhang G-F, Wang M, Yang H-P, et al. (2016) Risk Factors
Associated with Renal Involvement in Childhood Henoch-SchoÈnlein Purpura:
A Meta- Analysis. PLoS ONE 11(11): e0167346. doi:10.1371/journal.pone.0167346
26. Rigante D, Candelli M, Federico G, Bartolozzi F, Porri MG, Stabile A.Predictive factors of renal involvement or relapsing disease in children with Henoch-Schonlein purpura.Rheumatol Int.2005; 25(1):45-48. doi: 10.1007/s00296-004-0452-2 PMID: 15007622
27. Pillebout E, Jamin A, Ayari H, Housset P, Pierre M, Sauvaget V, et al. (2017) Biomarkers of IgA vasculitis nephritis in children. PLoS ONE 12 (11): e0188718.https://doi.org/10.1371/journal. pone.0188718
28. Nickavar A, Mehrazma M, Lahouti A. Clinicopathologic Correlations in Henoch-Schonlein Nephritis. Iranian Journal of Kidney Diseases. 2012 Nov; 6(6):437±440. PMID: 23146981
29. Kidney Disease: Improving global outcomes (KDIGO). Henoch– –Schönlein purpura. Kidney Int Suppl. 2012(11):218–220.
30. Ozen S, Marks SD, Brogan P, Groot N, de Graeff N, Avcin T. European consensus-based recommendations for diagnosis and treatment of immunoglobulin A vasculitis-the SHARE initiative. Rheumatology 2019;58:1607-16
31. 2018 - KDIGO Clinical Practice Guideline for Glomerulonephritis. KDIGO GN Guideline update - Evidence summary. (https://kdigo. org/wp-content/uploads/2018/08/Chap-12-Lupus nephritisevidence- summary_final_profiles.pdf).
32. Karadağ ŞG, Çakmak F, Çil B, et al. The relevance of practical laboratory markers in predicting gastrointestinal and renal involvement in children with Henoch-Schönlein Purpura [published online ahead of print, 2020 Aug 19]. Postgrad Med. 2020;1-6. doi:10.1080/00325481.2020.1807161. -
33. Pillebout E, Thervet E, Hill G, Alberti C, Vanhille P, Nochy D. Henoch-Schonlein Purpura in adults: outcome and prognostic factors. J Am Soc Nephrol 2002;13:1271-8.
34. Zaffanello M, Fanos V. Treatment-based literature of Henoch–Schön¬lein purpura nephritis in childhood. Pediatr Nephrol. 2009;24(10): 1901–1911.
35. Crayne CB, Eloseily E, Mannion ML, Azerf SP, Weiser P, Beukelman T. Rituximab treatment for chronic steroid-dependent Henoch-Schonlein purpura: 8 cases and a review of the literature. Pediatr Rheumatol Online J 2018;16:71.
36. Lafayette RA, Canetta PA, Rovin BH, Appel GB, Novak J, Nath KA. A Randomized, Controlled Trial of Rituximab in IgA Nephropathy with Proteinuria and Renal Dysfunction. J Am Soc Nephrol 2017;28:1306-13.
.
- Abstract Viewed: 329 times
- PDF Downloaded: 197 times