ESPN 51th Annual Meeting

ESPN 2018


 
Histological prognostic factors in children with Hennoch Schönlein Purpura nephritis
JEAN-DANIEL DELBET 1 GUILLAUME GESLAIN 1 GEORGES DESCHENES 2 TIM ULINSKI 1

1- TROUSSEAU HOSPITAL
2- ROBERT DEBRE HOSPITAL
 
Introduction:

The management of IgA vasculitis nephritis (IgAVN) remains controversial because of the difficulty to identify prognostic factors. This study reports the prognosis of children with IgAVN depending on histological parameters.

Material and methods:

All children with IgAVN diagnosed between 1995 and 2015 in two pediatric nephrology centers were included. Several histological parameters were reported: mesangial proliferation (MP), endocapillary proliferation (EP), crescents, active or chronic tubular and interstitial lesions (TIa lesions / TIc lesions) and segmental glomerulosclerosis (SG). Clinical and biological data were collected at the time of renal biopsy. The primary endpoint was IgAVN remission defined as a proteinuria < 200mg/L.

Results:

111 children were included with a median age of 7.9 years. Acute glomerular or TI lesions including MP, EP, crescents and TIa lesions were observed, respectively, in 82%, 89%, 50% and 32% of patients. Chronic glomerular lesions including SG and TIc lesions were observed in 6 and 8% of patients. Median initial proteinuria, albuminemia and eGFR were respectively of 549 mg/mmol, 30 g/l and median eGFR was 112 ml/min/1,73m2. 86 (77.5%) patients were in remission at the end of a median follow up of 47 months. Univariate analysis found no statistical association between the probability of remission and each histological parameter. Younger patients had a higher remission probability than older patients.

Conclusions:

Our study underlines that one fourth of the patients with IgAVN remains proteinuric at the end of a 4-year follow-up. It remains difficult to establish histological or clinical prognostic factors probably due to the impact of steroid/immunosuppressive treatment. Chronic histological lesions are very rare in children with IgAVN, which makes it difficult to use the Oxford Classification to evaluate these patients. because of a short duration of follow up. Oxford Classification does not seem appropriate to evaluate IgAVN prognosis because of a very low prevalence of chronic lesions.