Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Pediatr Int. 2024 Jan-Dec;66(1):e15781. doi: 10.1111/ped.15781.
Immumoglobulin A (IgA) vasculitis (IgAV), formerly known as Henoch-Schönlein purpura (HSP), is a self-limiting systemic vasculitis in children. Kidney involvement is associated with a long-term unfavorable outcome and can lead to significant morbidity. This study was conducted to describe the clinical and laboratory characteristics of childhood IgAV with kidney involvement and to identify risk factors associated with IgAV nephritis (IgAVN).
This was an ambidirectional descriptive study of 77 children with IgAV. All demographic data, clinical features, and laboratory tests were collected from electronic medical records from January 2010 to December 2022. Risk factors for kidney involvement in IgAV were assessed using multivariate logistic regression. Kaplan-Meier survival analysis was used to calculate the time to commencement of kidney involvement.
Twenty-five children (32.4% of the IgAV patients) developed IgAVN. The common findings in IgAV with kidney involvement were microscopic hematuria (100%), nephrotic range proteinuria (44%), and non-nephrotic range proteinuria (40%). Multivariate logistic regression showed that age greater than 10 years (adjusted hazard ratio, AHR 4.66; 95% confidence interval, CI, 1.91-11.41; p = 0.001), obesity (body mass index, BMI, z-score ≥ +2 standard deviations, SDs) (AHR 3.59; 95% CI 1.41-9.17; p = 0.007), and hypertension at onset (AHR 4.78; 95% CI 1.76-12.95; p = 0.002) were associated significantly with kidney involvement. During follow up, most IgAV patients developed nephritis within the first 9 months.
Age greater than 10 years, obesity, and hypertension at presentation were predictive factors for IgAVN. Our study emphasized that IgAV patients with risk factors should be closely monitored for at least 1 year after the onset of the disease.
免疫球蛋白 A（IgA）血管炎（IgAV），以前称为过敏性紫癜（HSP），是儿童中一种自限性全身性血管炎。肾脏受累与长期预后不良有关，并可导致显著的发病率。本研究旨在描述儿童 IgAV 合并肾脏受累的临床和实验室特征，并确定与 IgAV 肾炎（IgAVN）相关的危险因素。
这是一项回顾性描述性研究，纳入了 77 例 IgAV 患儿。所有人口统计学数据、临床特征和实验室检查均来自 2010 年 1 月至 2022 年 12 月的电子病历。采用多变量逻辑回归评估 IgAV 肾脏受累的危险因素。Kaplan-Meier 生存分析用于计算肾脏受累的起始时间。
25 例患儿（IgAV 患儿的 32.4%）发生 IgAVN。IgAV 合并肾脏受累的常见表现为镜下血尿（100%）、肾病范围蛋白尿（44%）和非肾病范围蛋白尿（40%）。多变量逻辑回归显示，年龄大于 10 岁（调整后的危险比，AHR 4.66；95%置信区间，CI，1.91-11.41；p=0.001）、肥胖（体质指数，BMI，z 评分≥+2 个标准差，SD）（AHR 3.59；95%CI 1.41-9.17；p=0.007）和起病时高血压（AHR 4.78；95%CI 1.76-12.95；p=0.002）与肾脏受累显著相关。在随访期间，大多数 IgAV 患者在发病后 9 个月内发展为肾炎。
年龄大于 10 岁、肥胖和起病时高血压是 IgAVN 的预测因素。本研究强调，具有危险因素的 IgAV 患者应在疾病发病后至少 1 年内密切监测。
