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Mizerska-Wasiak M, Turczyn A, Cichoń-Kawa K, Małdyk J, Miklaszewska M, Drożdż D, Bieniaś B, Sikora P, Drożyńska-Duklas M, Żurowska A, Szczepańska M, Pańczyk-Tomaszewska M. IgA vasculitis nephritis clinical course and kidney biopsy - national study in children. Pediatr Rheumatol Online J 2021; 19:150. [PMID: 34620183 PMCID: PMC8495907 DOI: 10.1186/s12969-021-00616-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/20/2021] [Indexed: 11/12/2022] Open
Abstract
UNLABELLED The aim of the study was to investigate the relationship between the severity of typical clinical symptoms, severity of histopathological lesions in kidney biopsies in IgA vasculitis nephritis (IgAVN) and to propose indications for kidney biopsy in children. MATERIAL AND METHODS This retrospective study enrolled 106 patients, included in the IgAVN registry of Polish children, diagnosed by kidney biopsy. Renal and extrarenal symptoms at onset of the disease were analyzed. Biopsy results were assessed using Oxford classifications (MEST-C). The patients were divided into 3 groups depending on the severity of proteinuria: A-nephrotic proteinuria with hematuria; B-non-nephrotic proteinuria with hematuria; C-isolated hematuria. RESULTS The first symptoms of nephropathy were observed at the 0.7 (1-128.4) months from the onset of extrarenal symptoms. Kidney biopsy was performed on 39 (6-782) days after the onset of nephropathy symptoms. MEST-C score 4 or 5 was significantly more frequent in children from group A than in groups B and C. Significantly higher mean MEST-C score was found in patients with abdominal symptoms than without. In group A: S0 and T0 we found in significantly shorter time to kidney biopsy than in S1, T1-2 p < 0.05) and in group B the significantly shorter time in T0 compare to T1-2 p < 0.05). The ROC analysis shows that S1 changes appear in kidney biopsies in group A with cut off 21 days (AUC 0,702, p = 0.004, sensitivity 0.895 specificity 0.444) T1-2 changes after 35 days (AUC 0.685, p = 0.022, sensitivity 0.750, specificity 0.615), and in goupn B T1-2 cut off is 74 days (AUC 0,738, p = 0.002, sensitivity 0.667, specificity 0.833). CONCLUSIONS In childhood IgAVN, the severity of changes in the urine is clearly reflected in the result of a kidney biopsy. The biopsy should be performed in patients with nephrotic proteinuria no later than 3 weeks after the onset of this symptom in order to promptly apply appropriate treatment and prevent disease progression. Accompanying abdominal symptoms predispose to higher MESTC score.
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Affiliation(s)
| | - Agnieszka Turczyn
- grid.13339.3b0000000113287408Department of Paediatrics and Nephrology, Medical University of Warsaw, Warsaw, Poland
| | - Karolina Cichoń-Kawa
- grid.13339.3b0000000113287408Department of Paediatrics and Nephrology, Medical University of Warsaw, Warsaw, Poland
| | - Jadwiga Małdyk
- grid.13339.3b0000000113287408Department of Pathomorphology, Medical University of Warsaw, Warsaw, Poland
| | - Monika Miklaszewska
- grid.5522.00000 0001 2162 9631Department of Pediatric Nephrology, Jagiellonian University, Collegium Medicum, Cracow, Poland
| | - Dorota Drożdż
- grid.5522.00000 0001 2162 9631Department of Pediatric Nephrology, Jagiellonian University, Collegium Medicum, Cracow, Poland
| | - Beata Bieniaś
- grid.411484.c0000 0001 1033 7158Department of Pediatric Nephrology, Medical University of Lublin, Lublin, Poland
| | - Przemysław Sikora
- grid.411484.c0000 0001 1033 7158Department of Pediatric Nephrology, Medical University of Lublin, Lublin, Poland
| | - Magdalena Drożyńska-Duklas
- grid.11451.300000 0001 0531 3426Department of Paediatrics, Nephrology and Hypertension, Medical University of Gdańsk, Gdansk, Poland
| | - Aleksandra Żurowska
- grid.11451.300000 0001 0531 3426Department of Paediatrics, Nephrology and Hypertension, Medical University of Gdańsk, Gdansk, Poland
| | - Maria Szczepańska
- grid.411728.90000 0001 2198 0923Department of Paediatrics, Medical University of Silesia, Zabrze, Poland
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Tan J, Tang Y, Zhong Z, Yan S, Tan L, Tarun P, Qin W. The efficacy and safety of immunosuppressive agents plus steroids compared with steroids alone in the treatment of Henoch–Schönlein purpura nephritis: A meta-analysis. Int Urol Nephrol 2019; 51:975-985. [DOI: 10.1007/s11255-019-02092-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 01/30/2019] [Indexed: 01/01/2023]
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Ozen S, Marks SD, Brogan P, Groot N, de Graeff N, Avcin T, Bader-Meunier B, Dolezalova P, Feldman BM, Kone-Paut I, Lahdenne P, McCann L, Pilkington C, Ravelli A, van Royen A, Uziel Y, Vastert B, Wulffraat N, Kamphuis S, Beresford MW. European consensus-based recommendations for diagnosis and treatment of immunoglobulin A vasculitis—the SHARE initiative. Rheumatology (Oxford) 2019; 58:1607-1616. [DOI: 10.1093/rheumatology/kez041] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 01/09/2019] [Indexed: 01/25/2023] Open
Abstract
Abstract
Objectives
IgA vasculitis (IgAV, formerly known as Henoch–Schönlein purpura) is the most common cause of systemic vasculitis in childhood. To date, there are no internationally agreed, evidence-based guidelines concerning the appropriate diagnosis and treatment of IgAV in children. Accordingly, treatment regimens differ widely. The European initiative SHARE (Single Hub and Access point for paediatric Rheumatology in Europe) aims to optimize care for children with rheumatic diseases. The aim therefore was to provide internationally agreed consensus recommendations for diagnosis and treatment for children with IgAV.
Methods
Recommendations were developed by a consensus process in accordance with the EULAR standard operating procedures. An extensive systematic literature review was performed, and evidence-based recommendations were extrapolated from the included papers. These were evaluated by a panel of 16 international experts via online surveys and subsequent consensus meeting, using nominal group technique. Recommendations were accepted when ⩾80% of experts agreed.
Results
In total, 7 recommendations for diagnosis and 19 for treatment of paediatric IgAV were accepted. Diagnostic recommendations included: appropriate use of skin and renal biopsy, renal work-up and imaging. Treatment recommendations included: the importance of appropriate analgesia and angiotensin-converting enzyme inhibitor use and non-renal indications for CS use, as well as a structured approach to treating IgAV nephritis, including appropriate use of CS and second-line agents in mild, moderate and severe disease along with use of angiotensin-converting enzyme inhibitors and maintenance therapy.
Conclusion
The SHARE initiative provides international, evidence-based recommendations for the diagnosis and treatment of IgAV that will facilitate improvement and uniformity of care.
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Affiliation(s)
- Seza Ozen
- Department of Paediatrics, Hacettepe University, Ankara, Turkey
| | - Stephen D. Marks
- Great Ormond Street Hospital for Children NHS Foundation Trust, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Paul Brogan
- Great Ormond Street Hospital for Children NHS Foundation Trust, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Noortje Groot
- Wilhelmina Children’s Hospital, University Medical Center, Utrecht
- Sophia Children’s Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Nienke de Graeff
- Wilhelmina Children’s Hospital, University Medical Center, Utrecht
| | - Tadej Avcin
- Department of Paediatric Rheumatology, University Children’s Hospital Ljubljana, Ljubljana, Slovenia
| | | | - Pavla Dolezalova
- General University Hospital and 1 Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Brian M. Feldman
- The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Isabelle Kone-Paut
- Department of Paediatric Rheumatology, Bicêtre University Hospital, Paris, France
| | - Pekka Lahdenne
- Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Liza McCann
- Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Clarissa Pilkington
- Great Ormond Street Hospital for Children NHS Foundation Trust, University College London Great Ormond Street Institute of Child Health, London, UK
| | | | - Annet van Royen
- Wilhelmina Children’s Hospital, University Medical Center, Utrecht
| | - Yosef Uziel
- Meir Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | - Bas Vastert
- Wilhelmina Children’s Hospital, University Medical Center, Utrecht
| | - Nico Wulffraat
- Wilhelmina Children’s Hospital, University Medical Center, Utrecht
| | - Sylvia Kamphuis
- Sophia Children’s Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Michael W. Beresford
- Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
- Institute of Translational Medicine, University of Liverpool and Alder Hey children's NHS Foundation Trust, Members of Liverpool Health Partners, Liverpool, UK
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Buscatti I, Casella B, Aikawa N, Watanabe A, Fahrat S, Campos L, Silva C. NEFRITE NA PÚRPURA HENOCH SCHONLEIN: FATORES DE RISCO INICIAIS E EVOLUÇÃO. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2017.07.581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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