Assadi Farahnak
Department of Pediatrics, Section of Nephrology, Rush University Medical Center, Chicago 60612, USA.
Iran J Kidney Dis. 2009 Jan;3(1):17-21.
Risk factors of renal involvement in Henoch-Schonlein nephritis (HSN) have been extensively studied, but their relations with the severity of glomerular lesions at the disease onset are much less known.
Data were collected retrospectively on 45 patients (age range, 2 to 15 years) with HSN to identify the initial clinical and laboratory features that most accurately correlate with histological findings. Nephritic syndrome was defined as hypertension, proteinuria, hematuria, and a creatinine clearance of 60 mL/min/1.73 m2 or less. Kidney biopsy findings were graded according to the International Study of Kidney Disease in Children classification for HSN.
Purpura was present in all the 45 children, arthritis in 73.3%, abdominal symptoms with or without bleeding in 68.6%, and a high serum IgA level in 24.4%. Hematuria was present in 88.6% of the patients, hematuria and proteinuria (not in nephrotic range) in 66.7%, nephrotic syndrome in 17.8%, acute nephritic syndrome in 8.9%, and nephritic-nephrotic syndrome in 13.3%. Grades II (33.3%) and III (22.2%) lesions were the most common pathologic findings on kidney biopsy followed by grades IV (17.8%), V (15.6%), and I (11.1%) lesions. Univariate analysis demonstrated that nephrotic syndrome, acute nephritic syndrome and a creatinine clearance less than 30 mL/min/1.73 m2 were all associated with a significantly increased risk of developing grades IV and/or V lesions. multivariate analysis showed nephritic-nephrotic syndrome as significant independent predictors of severity of glomerular disease at onset.
The severity of renal symptoms at onset determines the intensity of glomerular lesions.
过敏性紫癜性肾炎（HSN）肾脏受累的危险因素已得到广泛研究，但其与疾病发作时肾小球病变严重程度的关系却鲜为人知。
回顾性收集45例（年龄范围2至15岁）HSN患者的数据，以确定与组织学结果最准确相关的初始临床和实验室特征。肾炎综合征定义为高血压、蛋白尿、血尿以及肌酐清除率为60 mL/min/1.73 m2或更低。肾脏活检结果根据儿童肾脏病国际研究中HSN的分类进行分级。
45例儿童均有紫癜，73.3%有关节炎，68.6%有腹部症状伴或不伴出血，24.4%有血清IgA水平升高。88.6%的患者有血尿，66.7%有血尿和蛋白尿（非肾病范围），17.8%有肾病综合征，8.9%有急性肾炎综合征，13.3%有肾炎-肾病综合征。II级（33.3%）和III级（22.2%）病变是肾脏活检最常见的病理结果，其次是IV级（17.8%）、V级（15.6%）和I级（11.1%）病变。单因素分析表明，肾病综合征、急性肾炎综合征以及肌酐清除率低于30 mL/min/1.73 m2均与发生IV级和/或V级病变的风险显著增加相关。多因素分析显示，肾炎-肾病综合征是疾病发作时肾小球疾病严重程度的重要独立预测因素。
发病时肾脏症状的严重程度决定了肾小球病变的程度。
