Jean-Daniel Delbet1,2, Guillaume Geslain3, Martin Auger3, Julien Hogan4,5, Rémi Salomon6, Michel Peuchmaur4, Georges Deschênes4,5, David Buob7, Cyrielle Parmentier3, Tim Ulinski3,8. 1. Pediatric Nephrology unit, Trousseau Hospital, APHP.6, DMU Origyne, 26 Avenue du Docteur Arnold Netter, 75012, Paris, France. jeandaniel.delbet@aphp.fr. 2. Sorbonne Université, Paris 6, Paris, France. jeandaniel.delbet@aphp.fr. 3. Pediatric Nephrology unit, Trousseau Hospital, APHP.6, DMU Origyne, 26 Avenue du Docteur Arnold Netter, 75012, Paris, France. 4. Pediatric Nephrology, Robert Debré Hospital, APHP, Paris, France. 5. University Paris Diderot, Paris 7, Paris, France. 6. Pediatric Nephrology, Necker Enfants Malades, APHP, Paris, France. 7. Pathology Department, Tenon Hospital, APHP, Paris, France. 8. Sorbonne Université, Paris 6, Paris, France.
Abstract
BACKGROUND: The management of IgA vasculitis with nephritis (IgAVN) remains controversial because of the difficulty to identify prognostic factors. This study reports the prognosis of children with IgAVN in relation to histological parameters. METHODS: All children with IgAVN diagnosed between 2000 and 2015 in three pediatric nephrology centers were included. The following histological parameters were analyzed: mesangial proliferation (MP), endocapillary proliferation (EP), crescents, active, or chronic tubular and interstitial lesions (TIa lesions/TIc lesions), and segmental glomerulosclerosis (GS). Clinical and biological data were collected at the time of renal biopsy. The primary endpoint was IgAVN remission defined as a proteinuria < 200 mg/l without renal failure. RESULTS: One hundred fifty-nine children were included with a median age of 7.6 years. Acute glomerular or TI lesions including MP, EP, crescents, and TIa lesions were observed, respectively, in 81%, 86%, 49%, and 21% of patients. Chronic glomerular lesions including GS and TIc lesions were observed in 6 and 7% of patients. Median initial proteinuria was 330 mg/mmol, albuminemia 32 g/l, and eGFR 110 ml/min/1.73 m2. One hundred twelve (70%) patients were in remission at the end of a median follow-up of 37.4 months. Chronic lesions were significantly associated with the absence of remission in multivariate analysis, whereas EP, crescents and TIa were not associated with a poor prognosis. CONCLUSIONS: Of children with IgAVN, 30% present a persistent renal disease at the end of a 3-year follow-up. Chronic histological lesions, but not EP or crescents, are associated with a bad prognosis and must be evaluated in IgAVN histological classification.
BACKGROUND: The management of IgA vasculitis with nephritis (IgAVN) remains controversial because of the difficulty to identify prognostic factors. This study reports the prognosis of children with IgAVN in relation to histological parameters. METHODS: All children with IgAVN diagnosed between 2000 and 2015 in three pediatric nephrology centers were included. The following histological parameters were analyzed: mesangial proliferation (MP), endocapillary proliferation (EP), crescents, active, or chronic tubular and interstitial lesions (TIa lesions/TIc lesions), and segmental glomerulosclerosis (GS). Clinical and biological data were collected at the time of renal biopsy. The primary endpoint was IgAVN remission defined as a proteinuria < 200 mg/l without renal failure. RESULTS: One hundred fifty-nine children were included with a median age of 7.6 years. Acute glomerular or TI lesions including MP, EP, crescents, and TIa lesions were observed, respectively, in 81%, 86%, 49%, and 21% of patients. Chronic glomerular lesions including GS and TIc lesions were observed in 6 and 7% of patients. Median initial proteinuria was 330 mg/mmol, albuminemia 32 g/l, and eGFR 110 ml/min/1.73 m2. One hundred twelve (70%) patients were in remission at the end of a median follow-up of 37.4 months. Chronic lesions were significantly associated with the absence of remission in multivariate analysis, whereas EP, crescents and TIa were not associated with a poor prognosis. CONCLUSIONS: Of children with IgAVN, 30% present a persistent renal disease at the end of a 3-year follow-up. Chronic histological lesions, but not EP or crescents, are associated with a bad prognosis and must be evaluated in IgAVN histological classification.
Entities:
Keywords:
Henoch-Schönlein purpura nephritis; Histological prognostic factors; IgA vasculitis with nephritis; Pediatric; Renal outcomes
Authors: Daniel C Cattran; Rosanna Coppo; H Terence Cook; John Feehally; Ian S D Roberts; Stéphan Troyanov; Charles E Alpers; Alessandro Amore; Jonathan Barratt; Francois Berthoux; Stephen Bonsib; Jan A Bruijn; Vivette D'Agati; Giuseppe D'Amico; Steven Emancipator; Francesco Emma; Franco Ferrario; Fernando C Fervenza; Sandrine Florquin; Agnes Fogo; Colin C Geddes; Hermann-Josef Groene; Mark Haas; Andrew M Herzenberg; Prue A Hill; Ronald J Hogg; Stephen I Hsu; J Charles Jennette; Kensuke Joh; Bruce A Julian; Tetsuya Kawamura; Fernand M Lai; Chi Bon Leung; Lei-Shi Li; Philip K T Li; Zhi-Hong Liu; Bruce Mackinnon; Sergio Mezzano; F Paolo Schena; Yasuhiko Tomino; Patrick D Walker; Haiyan Wang; Jan J Weening; Nori Yoshikawa; Hong Zhang Journal: Kidney Int Date: 2009-07-01 Impact factor: 10.612
Authors: O Soylemezoglu; O Ozkaya; S Ozen; A Bakkaloglu; R Dusunsel; H Peru; A Cetinyurek; N Yildiz; O Donmez; N Buyan; S Mir; N Arisoy; A Gur-Guven; H Alpay; M Ekim; N Aksu; A Soylu; F Gok; H Poyrazoglu; F Sonmez Journal: Nephron Clin Pract Date: 2009-05-13
Authors: Joseph G Maliakkal; M John Hicks; Mini Michael; David T Selewski; Katherine Twombley; Michelle N Rheault; Meredith Seamon; Jason M Misurac; Cheryl L Tran; Loretta Reyes; Joseph T Flynn; Ali M Onder; Alexandru R Constantinescu; Vaishali Singh; Cynthia Pan; Abiodun Omoloja; Qiang Wu; William E Smoyer; Guillermo Hidalgo; Scott E Wenderfer Journal: J Clin Med Date: 2020-07-26 Impact factor: 4.241