Hennies, Imke, Gimpel, Charlotte, Gellermann, Jutta, Moeller, Kristina, Mayer, Brigitte, Dittrich, Katalin, Buescher, Anja K., Hansen, Matthias, Aulbert, Wiebke, Wuehl, Elke, Nissel, Richard, Schalk, Gessa, Weber, Lutz T., Pohl, Michael, Wygoda, Simone, Beetz, Rolf, Klaus, Guenter, Fehrenbach, Henry, Konig, Sabine, Staude, Hagen, Beringer, Ortraud, Bald, Martin, Walden, Ulrike, von Schnakenburg, Christian, Bertram, Gunhard, Wallot, Michael, Haeffner, Karsten, Wiech, Thorsten ORCID: 0000-0003-4053-1474, Hoyer, Peter F. and Pohl, Martin (2018). Presentation of pediatric Henoch-Schonlein purpura nephritis changes with age and renal histology depends on biopsy timing. Pediatr. Nephrol., 33 (2). S. 277 - 287. NEW YORK: SPRINGER. ISSN 1432-198X

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Abstract

This study correlates the clinical presentation of Henoch-Schonlein purpura nephritis (HSPN) with findings on initial renal biopsy. Data from 202 pediatric patients enrolled in the HSPN registry of the German Society of Pediatric Nephrology reported by 26 centers between 2008 and 2014 were analyzed. All biopsy reports were re-evaluated for the presence of cellular crescents or chronic pathological lesions (fibrous crescents, glomerular sclerosis, tubular atrophy > 5%, and interstitial fibrosis > 5%). Patients with HSPN with cellular glomerular crescents were biopsied earlier after onset of nephritis (median 24 vs 36 days, p = 0.04) than those without, whereas patients with chronic lesions were biopsied later (57 vs 19 days, p < 0.001) and were older (10.3 vs 8.6 years, p = 0.01) than those without. Patients biopsied more than 30 days after the onset of HSPN had significantly more chronic lesions (52 vs 22%, p < 0.001), lower eGFR (88 vs 102 ml/min/1.73m(2), p = 0.01), but lower proteinuria (2.3 vs 4.5 g/g, p < 0.0001) than patients biopsied earlier. Children above 10 years of age had lower proteinuria (1.98 vs 4.58 g/g, p < 0.001), lower eGFR (86 vs 101 ml/min/1.73m(2), p = 0.002) and were biopsied significantly later after onset of nephritis (44 vs 22 days, p < 0.001) showing more chronic lesions (45 vs 30%, p = 0.03). Proteinuria and renal function at presentation decreased with age. In summary, we find an age-dependent presentation of HSPN with a more insidious onset of non-nephrotic proteinuria, impaired renal function, longer delay to biopsy, and more chronic histopathological lesions in children above the age of 10 years. Thus, HSPN presents more like Immunoglobulin A (IgA) nephritis in older than in younger children.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Hennies, ImkeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gimpel, CharlotteUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gellermann, JuttaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Moeller, KristinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mayer, BrigitteUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Dittrich, KatalinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Buescher, Anja K.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hansen, MatthiasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Aulbert, WiebkeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wuehl, ElkeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Nissel, RichardUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schalk, GessaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Weber, Lutz T.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pohl, MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wygoda, SimoneUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Beetz, RolfUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Klaus, GuenterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fehrenbach, HenryUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Konig, SabineUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Staude, HagenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Beringer, OrtraudUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bald, MartinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Walden, UlrikeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
von Schnakenburg, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bertram, GunhardUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wallot, MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Haeffner, KarstenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wiech, ThorstenUNSPECIFIEDorcid.org/0000-0003-4053-1474UNSPECIFIED
Hoyer, Peter F.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pohl, MartinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-198259
DOI: 10.1007/s00467-017-3794-1
Journal or Publication Title: Pediatr. Nephrol.
Volume: 33
Number: 2
Page Range: S. 277 - 287
Date: 2018
Publisher: SPRINGER
Place of Publication: NEW YORK
ISSN: 1432-198X
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
CHILDHOOD IGA NEPHROPATHY; OXFORD CLASSIFICATION; CONTROLLED-TRIAL; PULSE THERAPY; FOLLOW-UP; CHILDREN; METHYLPREDNISOLONE; LESIONS; RISKMultiple languages
Pediatrics; Urology & NephrologyMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/19825

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