Zhang Guo-Zhen, Wu Xiao-Chuan, Yi Hong, Peng Xiao-Jie, Dang Xi-Qiang, He Xiao-Jie, Yi Zhu-Wen
Laboratory of Pediatric Nephrology, Second Xiangya Hospital of Central South University, Changsha, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2007 Apr;9(2):129-32.
This study investigated the clinical manifestations and renal pathological findings of 95 children with Henoch-Schonlein purpura nephritis (HSPN) in order to explore the relationship between clinical manifestations and renal pathology in HSPN.
According to clinical manifestations, 95 HSP patients were classified into six clinical groups: 1) normal urine analysis; 2) isolated hematuria or proteinuria; 3) proteinuria with hematuria; 4) acute nephritis; 5) nephrotic syndrome; 6) acute nephritis with over 50 mg/(kg.d) of proteinuria. The severity of the renal pathological findings was determined based on the classification of the International Study of Kidney Disease (ISKDC), including grades I-VI. The relationship between clinical manifestations and the severity of renal pathological findings was studied.
Nephrotic syndrome was the most common clinical diagnosis (26 cases), followed by proteinuria with hematuria (23 cases), normal urine analysis (20 cases), isolated hematuria or proteinuria (15 cases), acute nephritis with over 50 mg/(kg.d) of proteinuria (7 cases) and acute nephritis (4 cases). Twenty-five out of 26 patients with nephrotic syndrome had an ISKDC classification of grade III-IV. All of the four patients with acute nephrits had a classification of grade IIIb. The 7 cases of acute nephritis with over 50 mg/(kg.d) of proteinuria had a classification of grade IIIa-V. The 20 patients with normal urine analysis had a classification of grade Iia- IIIb. There were no significant differences in ISKDC classification among the patients with normal urine analysis, isolated hematuria or proteinuria, and hematuria plus proteinuria. As the course progressed, the degree of renal pathological changes in patients with isolated hematuria or proteinuria and hematuria plus proteinuria became more serious. Of all the 95 patients, 58% had co-deposition of immunoglobulins A, G and M. The percentage of co-deposition of immunoglobulins A, G and M was related to the disease course and the severity of renal pathological findings.
HSPN children with nephrotic syndrome or acute nephritis with or without proteinuria had relatively severe renal pathological changes. The clinical manifestations were not always in parallel with the severity of renal pathological findings in HSPN children. With the course progressing, the renal pathological changes tended to be serious. The severe renal pathological manifestations came with co-deposition of immunogolobulins A, G and M in the glomerulin.
本研究调查了95例过敏性紫癜性肾炎（HSPN）患儿的临床表现及肾脏病理结果，以探讨HSPN患儿临床表现与肾脏病理之间的关系。
根据临床表现，将95例HSP患者分为六个临床组：1）尿常规正常；2）单纯血尿或蛋白尿；3）血尿伴蛋白尿；4）急性肾炎；5）肾病综合征；6）蛋白尿超过50mg/（kg·d）的急性肾炎。根据国际肾脏病研究（ISKDC）分类确定肾脏病理结果的严重程度，包括I - VI级。研究临床表现与肾脏病理结果严重程度之间的关系。
肾病综合征是最常见的临床诊断（26例），其次是血尿伴蛋白尿（23例）、尿常规正常（20例）、单纯血尿或蛋白尿（15例）、蛋白尿超过50mg/（kg·d）的急性肾炎（7例）和急性肾炎（4例）。26例肾病综合征患者中有25例ISKDC分类为III - IV级。4例急性肾炎患者均为IIIb级。7例蛋白尿超过50mg/（kg·d）的急性肾炎患者分类为IIIa - V级。20例尿常规正常的患者分类为IIa - IIIb级。尿常规正常、单纯血尿或蛋白尿以及血尿加蛋白尿患者的ISKDC分类无显著差异。随着病程进展，单纯血尿或蛋白尿以及血尿加蛋白尿患者的肾脏病理改变程度加重。95例患者中，58%有免疫球蛋白A、G和M的共沉积。免疫球蛋白A、G和M的共沉积百分比与病程及肾脏病理结果的严重程度有关。
患有肾病综合征或伴有或不伴有蛋白尿的急性肾炎的HSPN患儿有相对严重的肾脏病理改变。HSPN患儿的临床表现并不总是与肾脏病理结果的严重程度平行。随着病程进展，肾脏病理改变趋于严重。严重的肾脏病理表现伴有免疫球蛋白A、G和M在肾小球中的共沉积。
