Mizerska-Wasiak Małgorzata, Cichoń-Kawa Karolina, Małdyk Jadwiga, Górska Elżbieta, Demkow Urszula, Pańczyk-Tomaszewska Małgorzata
Department of Pediatric and Nephrology, Medical University of Warsaw, Poland.
Department of Pathology, Medical University of Warsaw, Poland.
Cent Eur J Immunol. 2017;42(2):167-172. doi: 10.5114/ceji.2017.69359. Epub 2017 Aug 8.
The aim of the study was to evaluate the usefulness of urinary collagen IV (Col IV) excretion for predicting the severity of autoimmune renal inflammation in children with HSN (Henoch-Schönlein nephritis).
We studied 26 children, in whom HSN was diagnosed based on kidney biopsy. In all patients, urinalysis was performed and 24-hour urinary protein excretion was measured at the onset of the disease. All kidney biopsies were also scored using the Oxford classification: M - mesangial hypercellularity score (M0 absent, M1 present); E - presence of endocapillary proliferation (E0 absent, E1 present), S - segmental glomerulosclerosis/adhesion (S0 absent, S1 present), T - tubular atrophy/interstitial fibrosis (T0 ≤ 25%, T1 26-50%, T2 > 50%). The MEST score was calculated as the sum of M + E + S + T.
Urinary Col IV level was significantly higher in the study group than in control group. Urinary Col IV level was insignificantly higher in group A (nephrotic proteinuria) compared to the B (non-nephrotic proteinuria) and C (without proteinuria).We found no significant differences in the age at the disease onset, severity of proteinuria, and Col IV between groups 1 (S0, T0) and 2.(S1,T1/T2). The MEST score was significantly higher in group 2 than group 1.
Urinary Col IV excretion in children with HSN may be related to the lesions severity by the Oxford classification but seems to be associated with the mean value (the MEST score). In younger children, a more aggressive disease course is observed, and thus earlier and more aggressive treatment should be considered in this group.
本研究旨在评估尿Ⅳ型胶原（Col Ⅳ）排泄量对预测紫癜性肾炎（HSN）患儿自身免疫性肾炎症严重程度的作用。
我们研究了26例经肾活检确诊为HSN的患儿。所有患者在疾病发作时均进行了尿液分析并测定了24小时尿蛋白排泄量。所有肾活检标本也采用牛津分类法进行评分：M - 系膜细胞增多评分（M0无，M1有）；E - 毛细血管内增生情况（E0无，E1有），S - 节段性肾小球硬化/粘连（S0无，S1有），T - 肾小管萎缩/间质纤维化（T0≤25%，T1 26 - 50%，T2>50%）。计算MEST评分为M + E + S + T之和。
研究组尿Col Ⅳ水平显著高于对照组。与B组（非肾病性蛋白尿）和C组（无蛋白尿）相比，A组（肾病性蛋白尿）的尿Col Ⅳ水平虽有升高但无统计学意义。我们发现1组（S0，T0）和2组（S1，T1/T2）在疾病发作年龄、蛋白尿严重程度和Col Ⅳ方面无显著差异。2组的MEST评分显著高于1组。
HSN患儿的尿Col Ⅳ排泄量可能与牛津分类法所定义的病变严重程度相关，但似乎与平均值（MEST评分）有关。在年幼儿童中，观察到疾病进程更具侵袭性，因此对于该组患儿应考虑更早且更积极的治疗。
