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Younger DS. Headaches and Vasculitis. Neurol Clin 2024; 42:389-432. [PMID: 38575258 DOI: 10.1016/j.ncl.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Vasculitis refers to heterogeneous clinicopathologic disorders that share the histopathology of inflammation of blood vessels. Unrecognized and therefore untreated, vasculitis of the nervous system leads to pervasive injury and disability making this a disorder of paramount importance to all clinicians. Headache may be an important clue to vasculitic involvement of central nervous system (CNS) vessels. CNS vasculitis may be primary, in which only intracranial vessels are involved in the inflammatory process, or secondary to another known disorder with overlapping systemic involvement. Primary neurologic vasculitides can be diagnosed with assurance after intensive evaluation that incudes tissue confirmation whenever possible.
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Affiliation(s)
- David S Younger
- Department of Medicine, Section of Neuroscience, City University of New York School of Medicine, New York, NY, USA; Department of Neurology, White Plains Hospital, White Plains, NY, USA.
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Miki H, Tsuboi H, Kawashima F, Sugita T, Nishiyama T, Kuroda Y, Sawabe T, Uematsu N, Terasaki M, Kitada A, Honda F, Ohyama A, Yagishita M, Asashima H, Hagiwara S, Kondo Y, Matsumoto I. Multidrug-resistant IgA Vasculitis with Gastrointestinal Symptoms Successfully Treated with Intravenous Cyclophosphamide and Maintained with Mycophenolate Mofetil. Intern Med 2024; 63:743-747. [PMID: 37468247 PMCID: PMC10982010 DOI: 10.2169/internalmedicine.1990-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/06/2023] [Indexed: 07/21/2023] Open
Abstract
We present the case of a 17-year-old woman with IgA vasculitis (IgAV) who presented with relapsing gastrointestinal (GI) symptoms that were refractory to glucocorticoid and combination therapy with cyclosporine A, azathioprine or mycophenolate mofetil (MMF). The patient responded well to remission induction with intravenous cyclophosphamide (IVCY) and was successfully maintained with MMF. Remission induction with IVCY followed by maintenance therapy with MMF was effective in a patient with multidrug-resistant IgAV with GI lesions.
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Affiliation(s)
- Haruka Miki
- Department of Rheumatology, Institute of Medicine, University of Tsukuba, Japan
| | - Hiroto Tsuboi
- Department of Rheumatology, Institute of Medicine, University of Tsukuba, Japan
| | - Fumina Kawashima
- Department of Rheumatology, Institute of Medicine, University of Tsukuba, Japan
| | - Toshiki Sugita
- Department of Rheumatology, Institute of Medicine, University of Tsukuba, Japan
| | - Taihei Nishiyama
- Department of Rheumatology, Institute of Medicine, University of Tsukuba, Japan
| | - Yuki Kuroda
- Department of Rheumatology, Institute of Medicine, University of Tsukuba, Japan
| | - Tomonori Sawabe
- Department of Rheumatology, Institute of Medicine, University of Tsukuba, Japan
| | - Nana Uematsu
- Department of Rheumatology, Institute of Medicine, University of Tsukuba, Japan
| | - Mayu Terasaki
- Department of Rheumatology, Institute of Medicine, University of Tsukuba, Japan
| | - Ayako Kitada
- Department of Rheumatology, Institute of Medicine, University of Tsukuba, Japan
| | - Fumika Honda
- Department of Rheumatology, Institute of Medicine, University of Tsukuba, Japan
| | - Ayako Ohyama
- Department of Rheumatology, Institute of Medicine, University of Tsukuba, Japan
| | - Mizuki Yagishita
- Department of Rheumatology, Institute of Medicine, University of Tsukuba, Japan
| | - Hiromitsu Asashima
- Department of Rheumatology, Institute of Medicine, University of Tsukuba, Japan
| | - Shinya Hagiwara
- Department of Rheumatology, Institute of Medicine, University of Tsukuba, Japan
| | - Yuya Kondo
- Department of Rheumatology, Institute of Medicine, University of Tsukuba, Japan
| | - Isao Matsumoto
- Department of Rheumatology, Institute of Medicine, University of Tsukuba, Japan
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Filleron A, Cezar R, Fila M, Protsenko N, Van Den Hende K, Jeziorski E, Occean B, Chevallier T, Corbeau P, Tran TA. Regulatory T and B cells in pediatric Henoch-Schönlein purpura: friends or foes? Arthritis Res Ther 2024; 26:52. [PMID: 38365843 PMCID: PMC10870453 DOI: 10.1186/s13075-024-03278-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/25/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Henoch-Schönlein purpura (HSP) is the most common immunoglobulin A-mediated systemic vasculitis in childhood. We studied immune dysregulation in HSP by analyzing regulatory T (Treg), T helper 3 (Th3), and regulatory B cell (Breg) subpopulations that might intervene in immune activation, IgA production, and HSP clinical manifestations. METHODS This prospective study included 3 groups of children: 30 HSP on acute phase, 30 HSP on remission, and 40 healthy controls (HCs) matched on age. Treg, Breg, and Th3 were analyzed by flow cytometry. Serum immunoglobulin and cytokine levels were quantified by ELISA and Luminex. RESULTS Treg frequencies were higher in acute HSP than in remitting HSP and HCs (6.53% [4.24; 9.21] vs. 4.33% [3.6; 5.66], p = 0.002, and vs. 4.45% [3.01; 6.6], p = 0.003, respectively). Activated Th3 cells (FoxP3 + Th3 cells) tend to be more abundant in HSP than in HCs (78.43% [50.62; 80.84] vs. 43.30% [40.20; 49.32], p = 0.135). Serum IgA, IL-17, and latency-associated peptide (a marker of the anti-inflammatory cytokine TGF-beta production) were significantly and inflammatory cytokines TNF-alpha, IL-1-beta, and IL-6 were non-significantly higher in HSP than HCs. Bregs were identical between the groups, but, in patients with renal impairment, Breg percentage was lower compared to those without. Treg removal in PBMC culture resulted in an increase in IgA production in HSP proving a negative regulatory role of Tregs on IgA production. CONCLUSIONS In pediatric HSP, immune activation persists in spite of an increase in Th3 and Tregs. Th3 could be involved in IgA hyperproduction, inefficiently downregulated by Tregs. Lack of Bregs appears linked to renal impairment.
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Affiliation(s)
- Anne Filleron
- IRMB, Montpellier University, INSERM U1183, Montpellier, France
- Department of Pediatrics, Nîmes University Hospital, Montpellier University, Service de Pédiatrie, Place du Pr R. Debré, 30029, Nîmes Cedex 9, France
| | - Renaud Cezar
- IRMB, Montpellier University, INSERM U1183, Montpellier, France
- Department of Immunology, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Marc Fila
- Department of Pediatric Nephrology, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Nastassja Protsenko
- Department of Pediatrics, Nîmes University Hospital, Montpellier University, Service de Pédiatrie, Place du Pr R. Debré, 30029, Nîmes Cedex 9, France
| | - Kathleen Van Den Hende
- Department of Pediatrics, Nîmes University Hospital, Montpellier University, Service de Pédiatrie, Place du Pr R. Debré, 30029, Nîmes Cedex 9, France
| | - Eric Jeziorski
- Department of Pediatric Infectious Diseases, Montpellier University Hospital, Univ Montpellier, INSERM, EFS, Univ Antilles, Montpellier, France
| | - Bob Occean
- Department of Epidemiology, Medical Statistics and Public Health, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Thierry Chevallier
- Department of Epidemiology, Medical Statistics and Public Health, Nîmes University Hospital, Montpellier University, Nîmes, France
- UMR 1302 Desbrest Institute of Epidemiology and Public Health, INSERM, University of Montpellier, Montpellier, France
| | - Pierre Corbeau
- Department of Immunology, Nîmes University Hospital, Montpellier University, Nîmes, France
- Institute of Human Genetics, CNRS UMR9002, Montpellier University, Montpellier, France
| | - Tu Anh Tran
- IRMB, Montpellier University, INSERM U1183, Montpellier, France.
- Department of Pediatrics, Nîmes University Hospital, Montpellier University, Service de Pédiatrie, Place du Pr R. Debré, 30029, Nîmes Cedex 9, France.
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Adler S. [Immunoglobulin A vasculitis]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2024; 65:114-121. [PMID: 38236411 DOI: 10.1007/s00108-023-01650-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 01/19/2024]
Abstract
The immune-mediated small vessel vasculitis is known as Schoenlein-Henoch purpura predominantly from pediatrics and in these cases occurs more frequently after infections of the upper airways. In adults, immunoglobulin A (IgA) vasculitis often proceeds more severely und recurrently with the classical tetrad of skin manifestations in the sense of leukocytoclastic vasculitis, joint affection, gastrointestinal involvement and IgA nephritis, in contrast to the mostly mild and self-limiting course in children. The background of this systemic vasculitis with formation of IgA immune complexes is considered to be an altered glycosylation of IgA, as this causes the exposure of binding sites for autoantibodies so that an immune complex reaction can be elicited. This ultimately leads to perivascular deposition of IgA and a further activation of neutrophils. Groundbreaking in the diagnostics is the histological detection of leukocytoclastic vasculitis and in cases of renal manifestations a kidney biopsy with characteristic deposits of immune complexes, which cannot be clearly differentiated from IgA nephropathy. The treatment is aimed at the respective manifestation and is mostly based on consensus recommendations due to the lack of randomized studies. In addition to immunosuppressive medication, in the presence of a chronic kidney disease general nephroprotection is becoming increasingly more important also by inhibition of sodium-glucose transporter 2 (SGLT2). The type and extent of kidney involvement and also rare cardiac manifestations are the main determinants of the prognosis. Continuous medical accompaniment of those affected is necessary due to the possible progression of the disease and the risk of recurrence.
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Affiliation(s)
- Sabine Adler
- Rheumatologie und Immunologie, Kantonsspital Aarau, Tellstraße 25, 5001, Aarau, Schweiz.
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Sunar Yayla EN, Bakkaloğlu SA. Does age at disease onset affect the clinical presentation and outcome in children with immunoglobulin A vasculitis? Arch Rheumatol 2023; 38:633-641. [PMID: 38125056 PMCID: PMC10728748 DOI: 10.46497/archrheumatol.2023.9914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/09/2023] [Indexed: 12/23/2023] Open
Abstract
Objectives The study aimed to determine whether there is a relationship between the age at diagnosis and the clinical, laboratory, and prognostic features in pediatric immunoglobulin A vasculitis (IgAV) patients. Patients and methods In this study, 539 pediatric IgAV patients (298 males, 241 females; mean age: 7.74±3.36 years; range, 1 to 17.8 years) were retrospectively evaluated between January 2005 and July 2020. The relationship between clinical findings and age at diagnosis was analyzed by univariate logistic regression analysis. Factors associated with renal involvement, steroid-dependent or refractory disease, and recurrence were examined. Results The median age of diagnosis was 7.1 (1-17.8) years in all patients. At the time of admission, purpura, abdominal pain, and arthritis were the most common clinical findings. At the time of diagnosis, there was a positive association between age and purpura and an inverse association with the presence of arthritis. There were associations between renal involvement and age at diagnosis (odds ratio=1.22, 95% confidence interval 1.13-1.31, p<0.001), follow-up time (p<0.001), no history of previous infection (p<0.001), and presence of gastrointestinal (GI) involvement (p=0.003). Significant relationships were found between the age at diagnosis, follow-up time, GI involvement, renal involvement, scrotal involvement, the C-reactive protein value at the time of diagnosis, and the presence of steroid-dependent disease. An association was found between recurrence and GI involvement. All refractory patients had renal involvement. Age at diagnosis (p<0.001) and follow-up time (p<0.001) was found to be associated with refractory disease. Conclusion Age at diagnosis and follow-up time may be associated with renal involvement and refractory and steroid-dependent disease in IgAV. In addition, there may be a relationship between steroid-dependent disease and renal, GI, and scrotal involvement and between GI involvement and recurrence.
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Affiliation(s)
- Emine Nur Sunar Yayla
- Department of Pediatrics, Division of Pediatric Rheumatology, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Sevcan A. Bakkaloğlu
- Department of Pediatrics, Division of Pediatric Rheumatology, Gazi University Faculty of Medicine, Ankara, Türkiye
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Younger DS. Systemic vasculitis and headache. Curr Opin Neurol 2023; 36:631-646. [PMID: 37865837 PMCID: PMC10624412 DOI: 10.1097/wco.0000000000001223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
PURPOSE OF REVIEW Vasculitis refers to heterogeneous clinicopathologic disorders that share the histopathology of inflammation of blood vessels. Unrecognized and therefore untreated, vasculitis of the nervous system or so called neurovasculitides, lead to pervasive injury and disability making these disorder of paramount importance to clinicians. RECENT FINDINGS Headache is an important clue to vasculitic involvement of central nervous system (CNS) vessels. CNS vasculitis may be primary, in which only intracranial vessels are involved in the inflammatory process, or secondary to another known disorder with overlapping systemic involvement. A suspicion of vasculitis based on the history, clinical examination, or laboratory studies warrants prompt evaluation and treatment to forestall progression and avert cerebral ischemia or infarction. There has been remarkable progress in the pathogenesis, diagnosis, and treatment of primary adult and pediatric CNS vasculitides predicated on achievements in primary systemic forms. SUMMARY Vasculitis can be diagnosed with certainty after intensive evaluation that includes tissue confirmation whenever possible. Clinicians must choose from among the available immune modulating, suppressive, and targeted immunotherapies to induce and maintain remission status and prevent relapse, tempered by the recognition of anticipated medication side effects.
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Affiliation(s)
- David S Younger
- Department of Medicine, Section of Neuroscience, City University of New York School of Medicine, New York, NY; Department of Neurology, White Plains Hospital, White Plains, New York, USA
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Williams CEC, Lamond M, Marro J, Chetwynd AJ, Oni L. A narrative review of potential drug treatments for nephritis in children with IgA vasculitis (HSP). Clin Rheumatol 2023; 42:3189-3200. [PMID: 37755547 PMCID: PMC10640478 DOI: 10.1007/s10067-023-06781-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 09/28/2023]
Abstract
Immunoglobulin A (IgA) vasculitis (IgAV, also known as Henoch-Schoenlein purpura, HSP) is the most common vasculitis of childhood. It usually presents with a simple, self-limiting disease course; however, a small subset of patients may develop kidney involvement (IgAV-N) which occurs 4-12 weeks after disease onset and is the biggest contributor to long-term morbidity. Treatment currently targets patients with established kidney involvement; however; there is a desire to work towards early prevention of inflammation during the window of opportunity between disease presentation and onset of significant nephritis. There are no clinical trials evaluating drugs which may prevent or halt the progression of nephritis in children with IgAV apart from the early use of corticosteroids which have no benefit. This article summarises the latest scientific evidence and clinical trials that support potential therapeutic targets for IgAV-N that are currently being developed based on the evolving understanding of the pathophysiology of IgAV-N. These span the mucosal immunity, B-cell and T-cell modulation, RAAS inhibition, and regulation of complement pathways, amongst others. Novel drugs that may be considered for use in early nephritis include TRF-budesonide; B-cell inhibiting agents including belimumab, telitacicept, blisibimod, VIS649, and BION-1301; B-cell depleting agents such as rituximab, ofatumumab, and bortezomib; sparsentan; angiotensin converting enzyme inhibitors (ACE-Is); and complement pathway inhibitors including avacopan, iptacopan, and narsoplimab. Further clinical trials, as well as pre-clinical scientific studies, are needed to identify mechanistic pathways as there may be an opportunity to prevent nephritis in this condition. Key Points • Kidney involvement is the main cause of long-term morbidity and mortality in IgA vasculitis despite the current treatment recommendations. • The evolving understanding of the pathophysiology of IgA vasculitis is allowing exploration of novel treatment options which target underlying immune pathways. • Novel treatments currently being trialled in IgA nephropathy may have benefit in IgA vasculitis due to the similarities in the underlying pathophysiology, such as TRF-budesonide, B-cell modulators, and complement inhibitors. • Further studies, including clinical trials of novel drugs, are urgently needed to improve the long-term outcomes for children with IgA vasculitis nephritis.
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Affiliation(s)
- Chloe E C Williams
- Royal Liverpool and Broadgreen University Hospital Trusts, Liverpool, UK
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Megan Lamond
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Julien Marro
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Andrew J Chetwynd
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Centre for Proteome Research, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Louise Oni
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
- Department of Paediatric Nephrology, Institute in the Park Building, University of Liverpool, Alder Hey Children's NHS Foundation Trust Hospital, Eaton Road, Liverpool, L12 2AP, UK.
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Guo H, Wang ZL, Tao Z. Delayed diagnosis of abdominal Henoch-Schonlein purpura in children: A case report. World J Clin Cases 2023; 11:6311-6317. [PMID: 37731573 PMCID: PMC10507560 DOI: 10.12998/wjcc.v11.i26.6311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND For children with abdominal Henoch-Schonlein purpura presenting abdominal pain as an initial symptom and severe clinical manifestations, but without purpura appearance on the skin, the diagnosis and treatment are relatively difficult. This study summarized the characteristics of this group of patients by literature review and provided additional references for further refinement of glucocorticoid therapy in this vasculitis. CASE SUMMARY A 6-year-old girl presented mainly with repeated abdominal pain and had received short-term out-of-hospital treatment with hydrocortisone. On day 7 after onset, gastroscopy revealed chronic non-atrophic gastritis and erosive duodenitis without purpuric rash, and no obvious resolution of the abdominal pain was found after treatment against infection and for protection of gastric mucosa. On day 14 the inflammatory indices continued to rise and the pain was relieved after enhanced anti-infective therapy, but without complete resolution. On day 19, the patient presented with aggravated abdominal pain with purplish-red dots on the lower limbs, by which Henoch-Schonlein purpura was confirmed. After 5 d of sequential treatment with methylprednisolone and prednisone, abdominal pain disappeared and she was discharged. CONCLUSION Henoch-Schonlein purpura-related rash may appear after long-term abdominal pain, and should be distinguished from acute and chronic gastrointestinal diseases at the early stage without typical rash. For bacterial infection-induced Henoch-Schonlein purpura, glucocorticoid therapy alone without clearing the infection may not relieve symptoms.
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Affiliation(s)
- Hui Guo
- Department of Pediatrics, West China Second University Hospital, Chengdu 610041, Sichuan Province, China
| | - Zhi-Ling Wang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu 610000, Sichuan Province, China
| | - Zhu Tao
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu 610000, Sichuan Province, China
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Yang K, Tang J, Li H, Zhang H, Ding J, Li Z, Luo J. LncRNAs in Kawasaki disease and Henoch-Schönlein purpura: mechanisms and clinical applications. Mol Cell Biochem 2023:10.1007/s11010-023-04832-x. [PMID: 37639198 DOI: 10.1007/s11010-023-04832-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023]
Abstract
Kawasaki disease (KD) and Henoch-Schönlein purpura (HSP) are the two most predominant types of childhood vasculitis. In childhood vasculitis, factors such as lack of sensitive diagnostic indicators and adverse effects of drug therapy may cause multiorgan system involvement and complications and even death. Many studies suggest that long noncoding RNAs (lncRNAs) are involved in the mechanism of vasculitis development in children and can be used to diagnose or predict prognosis by lncRNAs. In existing drug therapies, lncRNAs are also involved in drug-mediated treatment mechanisms and are expected to improve drug toxicity. The aim of this review is to summarize the link between lncRNAs and the pathogenesis of KD and HSP. In addition, we review the potential applications of lncRNAs in multiple dimensions, such as diagnosis, treatment, and prognosis prediction. This review highlights that targeting lncRNAs may be a novel therapeutic strategy to improve and treat KD and HSP.
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Affiliation(s)
- Kangping Yang
- Department of Pediatrics, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China.
| | - Jiayao Tang
- School of Pharmacy, Nanchang University, Nanchang, China
| | - Haoying Li
- Queen Mary School of Nanchang University, Nanchang, China
| | - Hejin Zhang
- The Second Clinical Medical College of Nanchang University, Nanchang, China
| | - Jiatong Ding
- The Second Clinical Medical College of Nanchang University, Nanchang, China
| | - Zelin Li
- The First Clinical Medical College of Nanchang University, Nanchang, China
| | - Jinghua Luo
- Department of Pediatrics, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China.
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Yu S, Feng W, Wang Y, Zhao M, Tu Y, Guo Z. Serum total bile acid levels assist in the prediction of acute intussusception with abdominal type Henoch-Schonlein purpura in children. Front Pediatr 2023; 11:1183470. [PMID: 37342527 PMCID: PMC10277492 DOI: 10.3389/fped.2023.1183470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/23/2023] [Indexed: 06/23/2023] Open
Abstract
Background The severe acute abdomen associated with Henoch-Schonlein purpura (HSP) is an acute intussusception (AI). There is no reliable specific marker for AI with abdominal-type HSP. The serum total bile acid (TBA) level is a new prognostic marker associated with the severity of intestinal inflammation. The purpose of this study was to identify the prognostic value of serum TBA levels for the diagnosis of AI in children with abdominal-type HSP. Methods A retrospective study of 708 patients with abdominal-type HSP was conducted, with demographic data, clinical symptoms, hepatic function index, immune function markers, and clinical outcomes assessed. Patients were divided into two groups: HSP (613 patients) and HSP with AI (95 patients). The data were analysed using SPSS 22.0. Results Of the 708 patients, the serum TBA levels were higher in the HSP with AI group than in the HSP group (P < 0.05). Logistic regression analysis showed that vomiting (OR = 396.492, 95% CI = 14.93-10,529.67, P < 0.001), haematochezia (OR = 87.436, 95% CI = 5.944-1,286.214, P = 0.001), TBA (OR = 16.287, 95% CI = 4.83-54.922, P < 0.001), and D-dimer (OR = 5.987, 95% CI = 1.892-15.834, P = 0.003) were independent risk factors for abdominal-type HSP with AI. Receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off serum TBA value (sensitivity = 91.58%, specificity = 84.67%, AUC = 93.6524%) was >3 μmol/L for predicting AI in children with abdominal-type HSP. In this group of HSP patients with AI, a serum TBA level ≥6.98 μmol/L was significantly associated with an increased incidence of operative treatment (51.85% vs. 75.61%, P = 0.0181), intestinal necrosis (9.26% vs. 29.27%, P = 0.0117), and length of hospital stay [15.76 ± 5.31 vs. 10.98 ± 2.83 (days), P < 0.0001]. Conclusion In children with HSP and AI, the serum TBA level was significantly higher. A novel but promising haematological indicator, the serum TBA level, helps identify HSP with and without AI and predicts intestinal necrosis in HSP with AI.
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Affiliation(s)
- Sijie Yu
- Department of Nephrology, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders (Chongqing), Children's Hospital of Chongqing Medical University, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Feng
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders (Chongqing), Children's Hospital of Chongqing Medical University, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
- Department of General Surgery, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Yi Wang
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders (Chongqing), Children's Hospital of Chongqing Medical University, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
- Department of General Surgery, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Maoyuan Zhao
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders (Chongqing), Children's Hospital of Chongqing Medical University, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
- Department of General Surgery, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Yuying Tu
- Department of General Surgery, Jiangxi Hospital Affiliated to Children’s Hospital of Chongqing Medical University, Jiangxi, China
- Jiangxi Children’s Medical Center, Jiangxi Maternal and Child Health Hospital, Jiangxi, China
| | - Zhenhua Guo
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders (Chongqing), Children's Hospital of Chongqing Medical University, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
- Department of General Surgery, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Department of General Surgery, Jiangxi Hospital Affiliated to Children’s Hospital of Chongqing Medical University, Jiangxi, China
- Jiangxi Children’s Medical Center, Jiangxi Maternal and Child Health Hospital, Jiangxi, China
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11
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Pharmacological importance of Kunxian Capsule in clinical applications and its adverse effects: A review. CHINESE HERBAL MEDICINES 2023. [DOI: 10.1016/j.chmed.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
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12
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Viral Infections May Be Associated with Henoch-Schönlein Purpura. J Clin Med 2023; 12:jcm12020697. [PMID: 36675626 PMCID: PMC9862009 DOI: 10.3390/jcm12020697] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/05/2023] [Accepted: 01/10/2023] [Indexed: 01/17/2023] Open
Abstract
Henoch-Schönlein purpura or IgA vasculitis is the most common type of pediatric vasculitis that may affect adults as well. It is classified as a type of small-vessel vasculitis. It can cause cutaneous and systemic symptoms with a minority of patients developing kidney failure. Little is known about the specific pathophysiology of this disorder, except that it is believed to occur in individuals with abnormally glycosylated IgA1. Serum aberrant IgA1 may form large antigen-antibody complexes which, due to a defective clearance, are able to deposit in the small vessels of the skin, kidney, gut, and joints. A variety of factors, including infectious agents, drugs, and vaccines, have been identified as potential triggers. The majority of cases are preceded by upper respiratory tract infections, and seasonal variations suggest a link with many pathogens. The etiologic agent most frequently associated with IgA vasculitis historically have been group A β-hemolytic streptococcus and common respiratory tract viruses. However, during the current coronavirus pandemic, SARS-CoV-2 infection was identified as a main trigger factor. In addition, IgA vasculitis has been observed following COVID-19 immunization. This review provides insights into the state of the art on the relationship between viral infections, viral vaccines, and Henoch-Schönlein purpura.
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13
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DeHoratius DM. Cutaneous small vessel vasculitis. Postgrad Med 2022; 135:44-51. [PMID: 36524408 DOI: 10.1080/00325481.2022.2159207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This review discusses the clinical manifestations of cutaneous small vessel vasculitis. The etiologies and work up will be explored as well as the treatment considerations. This entity is multifactorial and usually involves multiple specialties. The presentation can range from self-limited to life threatening, multi-organ failure. It is essential to be able to diagnose vasculitis and proceed with the appropriate laboratory studies and work-up. Finally, investigation of associated etiologies such as infection and drugs will guide additional diagnostic studies.
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Affiliation(s)
- Danielle M. DeHoratius
- Bryn Mawr Hospital – Dermatology, 825 Old Lancaster Road Suite 450 Bryn Mawr Pennsylvania, Pennsylvania, United States
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14
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Luo F, Li Y, Zhang Y, Song Y, Diao J. Bibliometric analysis of IgA vasculitis nephritis in children from 2000 to 2022. Front Public Health 2022; 10:1020231. [PMID: 36276396 PMCID: PMC9581235 DOI: 10.3389/fpubh.2022.1020231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/15/2022] [Indexed: 01/28/2023] Open
Abstract
Background IgA vasculitis Nephritis (IgAVN) is a kidney-damaging disease that occurs during the course of IgA vasculitis (IgAV) and is the most serious complication of IgAV. However, there is a lack of reports of bibliometric analysis of IgAVN in children. The purpose of this study is to conduct a bibliometric analysis of IgAVN in children from 2000 to 2022, to explore the current status and cutting-edge trends in the field of IgAVN in children, and to establish new directions for subsequent research. Methods Screening the literature in the field of IgAVN in children in the Web of Science Core Collection (WoSCC) from 2000 to 2022. Visual analysis of their annual publications, countries, institutions, authors, journals, keywords, and references were using CiteSpace5.8.R3 and VOSviewer1.6.18. Results A total of 623 publications were included in the study, since the beginning of 2014, there has been an overall increasing trend in the number of articles issued. The most prolific country and institution were China and Zhejiang University. The most frequently cited author was Coppo R, with 331 citations, who has made great contributions to IgAVN. Mao Jianhua, Lee JS and Wyatt Robert J were the most prolific authors, all with 9 articles. Pediatric Nephrology was the most published and cited journal. The highest burst strength keyword is IgA vasculitis, and the highest burst strength reference is Davin JC, 2014. Conclusion The research hotspots and trends predicted by the analysis of this study provide a reference for in-depth research in this field with a view to promoting the development of IgAVN research in children.
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Affiliation(s)
- Fei Luo
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China,Department of Pediatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yuzhe Li
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China,Department of Pediatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yuan Zhang
- Department of Pediatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China,College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yehong Song
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China,Department of Pediatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Juanjuan Diao
- Department of Pediatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China,*Correspondence: Juanjuan Diao
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15
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Yoshida M, Nambu R, Yasuda R, Sakaguchi H, Hara T, Iwama I, Mizuochi T. Dapsone for Refractory Gastrointestinal Symptoms in Children With Immunoglobulin A Vasculitis. Pediatrics 2022; 150:188779. [PMID: 35975615 DOI: 10.1542/peds.2021-055884] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/24/2022] Open
Abstract
Immunoglobulin A vasculitis (IgAV) is a systemic small-vessel vasculitis. Although corticosteroids (CS) are the primary treatment for gastrointestinal manifestations associated with IgAV, some patients develop refractory or recurrent symptoms such as vomiting and abdominal pain despite CS treatment. Dapsone, a synthetic sulfone antimicrobial, has been used to treat cutaneous purpura in IgAV, but few authors have reported its use for refractory gastrointestinal symptoms. In this retrospective observational study, we describe results in 7 children with IgAV who were treated with dapsone for abdominal pain resistant to CS. Dapsone rapidly relieved abdominal pain in all 7 patients, who then were tapered off CS without relapse. Side effects of mild methemoglobinemia and hemolysis appeared to be manageable with planned monitoring and dose adjustment; a single patient who discontinued dapsone had fatigue and hypoxia associated with methemoglobinemia. No side effects were life-threatening. Dapsone may be considered as a therapeutic option for gastrointestinal symptoms refractory to CS in children with IgAV.
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Affiliation(s)
- Masashi Yoshida
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan.,These authors contributed equally to this work
| | - Ryusuke Nambu
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan.,These authors contributed equally to this work
| | - Ryosuke Yasuda
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Hirotaka Sakaguchi
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Tomoko Hara
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Itaru Iwama
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Tatsuki Mizuochi
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan.,These authors contributed equally to this work
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16
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Epidemiology of biopsy-proven Henoch–Schönlein purpura nephritis in children: A nationwide survey in Japan. PLoS One 2022; 17:e0270796. [PMID: 35802668 PMCID: PMC9269900 DOI: 10.1371/journal.pone.0270796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 06/20/2022] [Indexed: 11/19/2022] Open
Abstract
Background Little is known about the epidemiology of Henoch–Schönlein purpura nephritis (HSPN). Methods We conducted a nationwide epidemiological survey of Japanese children aged 1 to 15 years with HSPN. Children who were newly diagnosed with HSPN by biopsy between January 2013 and December 2015 were eligible for the survey to clarify the incidence of HSPN. We also conducted an institutional survey on kidney biopsy criteria and treatment protocols. Results A total of 353 of 412 institutions (85.7%) responded to the questionnaire. Of the 353 institutions, 174 reported to perform kidney biopsies at their institutions, and 563 children were diagnosed with HSPN. Considering the collection rate, the estimated incidence of biopsy-proven HSPN was 1.32 cases/100,000 children per year. The median age at biopsy was 7.0 years, and the male-to-female ratio was 1.2:1. The kidney biopsy criteria and treatment protocols for HSPN were as follows. Patients with acute kidney injury underwent biopsy at least one month after onset. For patients without kidney dysfunction, the timing for biopsy was determined by the amount of proteinuria. Regarding the treatment of HSPN, there were certain commonalities among the treatment protocols, they eventually differed depending on the institutions involved. Conclusions The incidence of biopsy-proven HSPN was 1.32 cases/100,000 children per year in Japan. The male-to-female ratio and date of diagnosis of HSPN were similar to those in previous studies. The kidney biopsy criteria and treatment protocols for HSPN varied among institutions. Further studies are warranted to establish an optimal treatment policy based on the prognosis.
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17
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Wallace CE, Sharma A. Adult Onset Immunoglobulin A (IgA) Vasculitis Secondary to Group A Streptococcus Infection. Cureus 2022; 14:e23987. [PMID: 35541301 PMCID: PMC9084608 DOI: 10.7759/cureus.23987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/30/2022] [Indexed: 11/20/2022] Open
Abstract
Immunoglobulin A (IgA) vasculitis is a small blood vessel vasculitis that is mediated by immune complex deposition. While it is the most common cause of childhood vasculitis, the disease is uncommon in adults with variable clinical manifestations. A 65-year-old female presented with a diffuse erythematous, pruritic, painful rash across her legs, back, and arms of 12 days’ duration. Associated symptoms included fatigue, lower extremity swelling, and migratory arthralgias of the knees and ankles. Skin examination revealed edematous, blanchable, erythematous, annular papules and plaques on the legs, back, and arms with pitting edema of the lower legs. Laboratory testing revealed an elevated erythrocyte sedimentation rate, hypoalbuminemia, proteinuria, hematuria, and a positive antistreptolysin O titer, indicative of recent group A Streptococcus infection. Treatment with systemic corticosteroids led to a resolution of all her symptoms. Adult onset IgA vasculitis differs in clinical manifestation and treatment from that of the pediatric population. This case demonstrates the importance of considering IgA vasculitis as a differential diagnosis in adults presenting with small vessel vasculitis.
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18
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Neumann T. [Update on immunoglobulin A vasculitis]. Z Rheumatol 2022; 81:305-312. [PMID: 35303751 PMCID: PMC8932091 DOI: 10.1007/s00393-022-01162-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2021] [Indexed: 11/18/2022]
Abstract
Die Immunglobulin-A-Vaskulitis (IgAV) ist eine systemische Vaskulitis der kleinen Gefäße mit Ig(Immunglobulin)A-Immunkomplexbildung und einem breiten Spektrum klinischer Konstellationen. Typische Manifestationen sind Purpura, Arthralgien oder Arthritiden, Enteritis und Glomerulonephritis. Die IgAV ist die häufigste Vaskulitis im Kindesalter mit meist unkompliziertem und selbstlimitierendem Verlauf. Erwachsene erkranken deutlich seltener an einer IgAV, wobei die Verläufe insbesondere bei renaler oder gastrointestinaler Manifestation komplizierter sind. Verschiedene Trigger der IgAV, darunter Infektionen, wurden beschrieben, wobei eine gestörte Glykosylierung von IgA1 mit konsekutiver Freilegung von Bindungsstellen für Autoantikörper die pathophysiologische Voraussetzung für die Vaskulitis ist. Therapeutische Strategien mit Immunsuppressiva sind bisher mit geringer Evidenz unterlegt, berücksichtigen die Schwere der Organmanifestationen und orientieren sich an den Empfehlungen zur Behandlung anderer Vaskulitiden der kleinen Gefäße. Benigne Verläufe werden symptomatisch behandelt. Die langfristige Prognose der IgAV ist von der renalen Manifestation beeinflusst.
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Affiliation(s)
- Thomas Neumann
- Klinik für Rheumatologie, Kantonsspital St. Gallen, Rorschacher Str. 95, 9007, St. Gallen, Schweiz. .,Universität Zürich, Rämistrasse 71, 8006, Zürich, Schweiz.
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19
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Kang Z, Xun M, Li Z, Yang Z. Association of the clinicopathological characteristics and proteinuria remission of pediatric IgAV with nephrotic-range proteinuria: A retrospective cohort study. Front Pediatr 2022; 10:959212. [PMID: 36340706 PMCID: PMC9634576 DOI: 10.3389/fped.2022.959212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/29/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND IgA vasculitis (IgAV) combined with nephrotic-range proteinuria is uncommon, and nephrotic-range proteinuria is considered a risk factor for poor prognosis in children with IgAV. There are few clinical studies with large samples. METHODS Children with IgAV and nephrotic-range proteinuria who were hospitalized at the Department of Nephrology, Rheumatology and Immunology, Hunan Children's Hospital, from March 2008 to January 2020 were retrospectively studied; the patients were aged ≤18 years and were followed up for ≥12 months. We analyzed clinical characteristics, pathological changes, treatment responses, and their relationships in patients with IgAV combined with nephrotic-range proteinuria. RESULTS Two hundred seventy-seven children with an average age at onset of IgAV with nephritis (IgAVN) of 8.0 years (interquartile range (IQR), 6.0-10.0) were enrolled; 65.7% were aged 6-10 years. The male-to-female ratio was 1.35:1. All children had both nephrotic-range proteinuria and hematuria, 49 (17.7%) had hypoalbuminemia, and 9 (3.2%) had estimated glomerular filtration rate < 90 (mL/min/1.73 m2). All included children were followed up for at least 1 year. At 3, 6, and 12 months of follow-up, the remission rates of proteinuria in children with IgAV combined with nephrotic-range proteinuria were 27.8%, 62.1%, and 83.0%, respectively, and the remission rates of hematuria were 1.4%, 8.7%, and 35.7%, respectively. In addition, children with age at onset of IgAV with nephrotic-range proteinuria ≥10 years, who were female, who had proteinuria ≥100 mg/kg/24 h, and who had a pathological grade III or above had lower remission rates of hematuria and proteinuria (P < 0.05). Multivariate factor analysis was performed by logistic regression and showed age at onset of IgAVN ≥ 10 years and crescents to be risk factors for nonremission of proteinuria at 12 months of follow-up (P < 0.05). CONCLUSIONS Age at onset of IgAVN, sex, proteinuria level, pathological grade, and crescents significantly affect proteinuria remission in children with IgAV combined with nephrotic-range proteinuria.
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Affiliation(s)
- Zhijuan Kang
- Department of Pediatrics, Third Xiangya Hospital of Central South University, Changsha, China.,Department of Nephrology, Rheumatology and Immunology, Hunan Children's Hospital, Changsha, China
| | - Mai Xun
- Department of Nephrology, Rheumatology and Immunology, Hunan Children's Hospital, Changsha, China
| | - Zhihui Li
- Department of Nephrology, Rheumatology and Immunology, Hunan Children's Hospital, Changsha, China
| | - Zuocheng Yang
- Department of Pediatrics, Third Xiangya Hospital of Central South University, Changsha, China
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20
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Zhang L, Jia X, Lai P, Wang K, Bao Y, Li X. Relevance of Intestinal Microbiota in Immunoglobulin A Vasculitis With Abdominal Involvement. Front Pediatr 2022; 10:943267. [PMID: 35911834 PMCID: PMC9329519 DOI: 10.3389/fped.2022.943267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/21/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND We explored the intestinal microbiota changes in IgAV with abdominal involvement (IgAV-GI) at the acute and convalescent stages and evaluated the role of intestinal microbiota in the clinical course of patients with IgAV. METHODS A total of 37 patients with IgAV were included, and the control group comprised 37 age- and sex-matched healthy children. Stool samples were collected from 28 children with IgAV-GI (19 in the acute stage and 9 in the recovery stage) and from nine children with non-abdominal involvement. Fecal specimens were selected and DNA was obtained using an extraction kit which was then subjected to high-throughput sequencing and analysis. RESULTS There was no significant difference in the community structure of the intestinal microbiota among the IgAV-GI acute, IgAV-GI convalescence, and IgAV-non-GI stages. The abundance of Veillonella in the acute stage of IgAV-GI was significantly higher than that in IgAV-non-GI and convalescence stages, and Ruminococcus was the most abundant in IgAV-GI convalescence. The α-diversity of children with IgAV was significantly lower than that of healthy children, and healthy children had higher intestinal microbiota richness and more evenly distributed species. In terms of changes in intestinal microbial diversity in patients with IgAV at the genus level, obligate anaerobes such as Bifidobacterium, Prevotella, Coprobacter, Prevotella_9, Blautia, Romboutsia, Parabacteroide, Subdoligranulum, and Roseburia were significantly reduced, and the enrichment of facultative anaerobe was represented by Bacteroides, Lachnoclostridium, and Alistipe. CONCLUSION Different bacterial species may be involved in the pathogenesis of different types of IgAV-GI. Differences were observed in the intestinal microbiota between healthy children and children with IgAV.
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Affiliation(s)
- Linqian Zhang
- Jinhua Maternal and Child Health Care Hospital, Jinhua Women's and Children's Hospital, Jinhua, China
| | - Xinyi Jia
- Jinhua Maternal and Child Health Care Hospital, Jinhua Women's and Children's Hospital, Jinhua, China.,Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Panjian Lai
- Jinhua Maternal and Child Health Care Hospital, Jinhua Women's and Children's Hospital, Jinhua, China
| | - Kang Wang
- Jinhua Maternal and Child Health Care Hospital, Jinhua Women's and Children's Hospital, Jinhua, China
| | - Yunguang Bao
- Jinhua Maternal and Child Health Care Hospital, Jinhua Women's and Children's Hospital, Jinhua, China
| | - Xiaobing Li
- Jinhua Maternal and Child Health Care Hospital, Jinhua Women's and Children's Hospital, Jinhua, China
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21
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Kong Z, Zheng J, Wu J, Ou J, Zhou X, Huang H. Efficacy and safety of Xijiao Dihuang decoction in treating Henoch-Schönlein purpura: Study protocol for systematic review. Medicine (Baltimore) 2021; 100:e28291. [PMID: 34941115 PMCID: PMC8701453 DOI: 10.1097/md.0000000000028291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Henoch-Schönlein purpura is one of the most common systemic vascular inflflammatory disease in childhood with purpuric rash, arthritis, renal involvement, and abdominal pain. As a treatment for it, Xijiao Dihuang decoction, a traditional herbal formula, has been used. The object of this systematic review and meta-analysis is to assess the effificacy and safety on Xijiao Dihuang decoction in treating allergic purpura. METHODS The following electronic databases will be systematically searched up to November 7, 2019 for eligible studies: The Cochrane Library, Embase, PubMed, Web of Science, the Chinese National Knowledge Infrastructure (CNKI), the Chinese Biomedical LiteratureDatabase (CBM), the Chinese Scientifific Journal Database (VIP), andtheWanfang Database. Thetreatment group in the included studies will receive both routine western medicines and Xijiao Dihuang decoction, while the control group will receive routine western medicines. Data extraction and risk of bias assessments will be conducted by 2 independent reviewers. Heterogeneity will be assessed by I2 statistics, while reporting bias will be evaluated by funnel plots and Begg and Egger test. Sensitivity analysis and Subgroup analysis will be performed when necessary. Review Manager software (RevManV.5.3.0) and Stata will be used for all statistical analyses. Ethics approval is not required as no privacy data were involved. This systematic review and meta analysis will be published in a peer-reviewed journal. RESULTS This study could provide a systematically evaluated therapeutic efficacy and safety of XJDHD on patients with HSP via including RCTs that matches the needs. And we also expect to find predictors of treatment through subgroup analysis, helping patients with HSP detect as well as cope with the disease as early as possible. CONCLUSION The conclusion of our study will provide the systematical review of the efficacy and safety of XJDHD on patients with HSP, and provide predictors of treatment. PROSPERO REGISTRATION NUMBER PROSPERO CRD 42018111293.
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Affiliation(s)
- Zhiqian Kong
- Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Jiaming Zheng
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Junwei Wu
- The Seventh Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jianzhao Ou
- Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Xinyu Zhou
- Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Haiyan Huang
- Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
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22
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Luciana B, Ilaria C, Isabella C, Gentile C, Grasso EA, Di Donato G, Francesco C, Verrotti A. Epidemiological and clinical aspects of immunoglobulin A vasculitis in childhood: a retrospective cohort study. Ital J Pediatr 2021; 47:237. [PMID: 34911536 PMCID: PMC8672591 DOI: 10.1186/s13052-021-01182-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/09/2021] [Indexed: 12/31/2022] Open
Abstract
Background A retrospective study was conducted in order to investigate and describe the characteristics of Immunoglobulin A vasculitis (IgAV), previously known as Henoch-Schӧnlein purpura, in the paediatric population of a community-based healthcare delivery system in the Italian region of Abruzzo. Methods This is a population-based retrospective chart review of the diagnosis of IgAV in children ages 0 to 18, admitted to the Department of Paediatrics of Chieti and Pescara between 1 January 2000 and 31 December 2016. All children enrolled presented with clinical symptoms and laboratory findings and met the EULAR/PRINTO/PRES 2008 criteria. Results Two-hundred-eight children met the criteria for IgAV, with the highest incidence reported among children below 7-years of age. A correlation with recent infections was found in 64% of the cohort; the onset was more frequently during the winter and fall. Purpura had a diffuse distribution in the majority of patients; joint impairment was the second most frequent symptom (43%), whereas the gastrointestinal tract was involved in 28% of patients. Conclusions Hereby, we confirm the relative benignity of IgAV in a cohort of Italian children; with regards to renal involvement, we report a better outcome compared to other studies. However, despite the low rate of renal disease, we observed a wide use of corticosteroids, especially for the treatment of persistent purpura.
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Affiliation(s)
- Breda Luciana
- Department of Paediatrics, University of Chieti, Via dei Vestini 31, Chieti, Italy.
| | - Carbone Ilaria
- Department of Paediatrics, University of Chieti, Via dei Vestini 31, Chieti, Italy
| | - Casciato Isabella
- Department of Paediatrics, University of Chieti, Via dei Vestini 31, Chieti, Italy
| | - Cristina Gentile
- Department of Paediatrics, University of Chieti, Via dei Vestini 31, Chieti, Italy
| | | | - Giulia Di Donato
- Department of Paediatrics, University of Chieti, Via dei Vestini 31, Chieti, Italy
| | - Chiarelli Francesco
- Department of Paediatrics, University of Chieti, Via dei Vestini 31, Chieti, Italy
| | - Alberto Verrotti
- Department of Paediatrics, University of Perugia, Piazza dell'Università 1, Perugia, Italy
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23
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Song Y, Huang X, Yu G, Qiao J, Cheng J, Wu J, Chen J. Pathogenesis of IgA Vasculitis: An Up-To-Date Review. Front Immunol 2021; 12:771619. [PMID: 34858429 PMCID: PMC8630619 DOI: 10.3389/fimmu.2021.771619] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/21/2021] [Indexed: 11/13/2022] Open
Abstract
Immunoglobin A (IgA) vasculitis (IgAV), formerly called the Henoch-Schönlein purpura (HSP), is a small vessel vasculitis, characterized by IgA1-dominant immune deposition at diseased vessel walls. IgAV is the most common form of vasculitis in children; typical symptoms include palpable purpura, arthritis or arthralgia, abdominal pain, and hematuria or proteinuria. Galactose-deficient IgA1 is detected in the tissues of the kidney and skin in patients with IgAV; it forms immune complexes leading to subsequent immune reactions and injuries. This report provides the recent advances in the understanding of environmental factors, genetics, abnormal innate and acquired immunity, and the role of galactose-deficient IgA1 immunocomplexes in the pathogenesis of IgAV.
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Affiliation(s)
- Yan Song
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, China.,National Key Clinical Department of Kidney Diseases, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,The Third Grade Laboratory Under the National State, Administration of Traditional Chinese Medicine, Hangzhou, China
| | - Xiaohan Huang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, China.,National Key Clinical Department of Kidney Diseases, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,The Third Grade Laboratory Under the National State, Administration of Traditional Chinese Medicine, Hangzhou, China
| | - Guizhen Yu
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, China.,National Key Clinical Department of Kidney Diseases, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,The Third Grade Laboratory Under the National State, Administration of Traditional Chinese Medicine, Hangzhou, China
| | - Jianjun Qiao
- Department of Dermatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jun Cheng
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, China.,National Key Clinical Department of Kidney Diseases, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,The Third Grade Laboratory Under the National State, Administration of Traditional Chinese Medicine, Hangzhou, China
| | - Jianyong Wu
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, China.,National Key Clinical Department of Kidney Diseases, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,The Third Grade Laboratory Under the National State, Administration of Traditional Chinese Medicine, Hangzhou, China
| | - Jianghua Chen
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, China.,National Key Clinical Department of Kidney Diseases, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,The Third Grade Laboratory Under the National State, Administration of Traditional Chinese Medicine, Hangzhou, China
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Infective Endocarditis-Associated Purpura and Glomerulonephritis Mimicking IgA Vasculitis: A Diagnostic Pitfall. Am J Med 2021; 134:1539-1545.e1. [PMID: 34343512 DOI: 10.1016/j.amjmed.2021.06.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/11/2021] [Accepted: 06/19/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Purpura and glomerulonephritis are typical presentations in IgA vasculitis. Infective endocarditis mimicking IgA vasculitis by presenting with glomerulonephritis and purpura is rarely reported. METHODS We searched for cases with infective endocarditis-associated purpura and glomerulonephritis in a tertiary hospital in China and retrospectively reviewed their clinicopathological features. Differential diagnosis and treatment in patients with infective endocarditis-associated purpura and glomerulonephritis were discussed. RESULTS A total of 20 cases with infective endocarditis-associated purpura and glomerulonephritis were identified among 548 cases with infective endocarditis in our center during an 8-year period: 7 of the 20 cases (35%) were initially misdiagnosed as IgA vasculitis and 10 cases (50%) presented with left-sided endocarditis caused by Streptococcus viridans. Fever (100%, 20 out of 20), prior valvular deformities (80%, 16 out of 20), cardiac murmur (95%, 19 out of 20), splenomegaly (84%, 16 out of 19), embolism (55%, 11 out of 20), and hypocomplementemia (76%, 13 out of 17) were present in most patients. Crescents and mesangial hypercellularity with or without endothelial hypercellularity were the primary findings on light microscopy, with C3-dominant deposition on immunofluorescence. But IgA-dominant staining was also observed (40%, 2 out of 5). In patients with rapidly progressive glomerulonephritis, patients with complete recovery of renal function had shorter disease duration and higher ratio (67% vs 20%) of immunosuppressive therapy compared with patients with partial recovery. CONCLUSIONS Infective endocarditis-associated glomerulonephritis and purpura can closely mimic IgA vasculitis. Differential diagnosis is challenging, particularly when typical presentations of infective endocarditis are absent. In adults with presentations like IgA vasculitis, infective endocarditis should be evaluated through comprehensive clinical and pathological investigations. Immunosuppressive therapy can be considered in patients with severe glomerulonephritis who do not improve after proper anti-infective therapy.
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25
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Zhu Y, Wang S, Xu H, He H, Pan M. Real-time vascular and IgA dynamics during Henoch-Schönlein purpura by in vivo fluorescent microscopy. BIOMEDICAL OPTICS EXPRESS 2021; 12:7826-7834. [PMID: 35003869 PMCID: PMC8713681 DOI: 10.1364/boe.442454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 06/14/2023]
Abstract
Henoch-Schönlein purpura (HSP) is a typical cutaneous immune skin disease, usually diagnosed by invasive biopsy. In this study, we develop a noninvasive optical method by combining in vivo optical clearing, confocal microscopy and immune-staining together to present the real-time in vivo dynamics of blood vessels, IgA molecules, and T cells in a HSP rat model. The small vessels in the skin are found with acute damage and then hyperplasia, which enhances deposition of IgA complexes in blood vessels. The migrating T cells in blood vessels in HSP regions can be detected by setting fast line scanning in this method. Our method provides in vivo vascular, cellular, and molecular dynamics during HSP development and is thus of great potential in research and diagnosis of HSP and other skin diseases.
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Affiliation(s)
- Yujie Zhu
- Department of Dermatology, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Dermatology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shaoyang Wang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Hui Xu
- Department of Dermatology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hao He
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Meng Pan
- Department of Dermatology, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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26
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Association of kidney biopsy findings with short- and medium-term outcomes in children with moderate-to-severe IgA vasculitis nephritis. Eur J Pediatr 2021; 180:3209-3218. [PMID: 33934234 DOI: 10.1007/s00431-021-04065-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/31/2021] [Accepted: 04/04/2021] [Indexed: 10/21/2022]
Abstract
Assessing the initial severity of immunoglobulin A vasculitis nephritis (IgAV-N) is important due to its determining effect on kidney management and outcomes. This paper describes a multicentre paediatric cohort of IgAV-N patients and discusses relationships among clinical presentation, histological features, and kidney outcome. We retrospectively studied a cohort of 170 children with biopsy-proven IgAV-N, diagnosed between 2007 and 2017. One-quarter of the cohort (27%) presented with initial nephrotic syndrome (NS). Kidney biopsy revealed International Study of Kidney Disease (ISKDC) grade II or grade III in 83% of cases. Endocapillary proliferation was observed in 73% of patients, and chronic lesions were observed in 25%. Data analysis showed a significant association between NS at onset and endocapillary proliferation and cellular crescents. After a median follow-up of 21 months (IQR 12-39), 30% of patients had persistent proteinuria or decreased eGFR. At the end of follow-up, kidney impairment was more often observed in patients with NS at onset and those with cellular crescents and chronic lesions on initial kidney biopsy.Conclusion: This study highlights the relationship between the clinical and histological presentation of IgAV-N and the factors that affect kidney outcome. The ISKDC classification may be improved by including lesions that are more discriminating for disease severity and prognosis. What is Known: • Nephrotic syndrome (NS) or kidney failure at diagnosis and cellular crescents in more than 50% of the glomeruli are recognized as risk factors for poor kidney outcome in immunoglobulin A vasculitis nephritis (IgAV-N). • The reference histological classification of the International Study of Kidney Disease in Children (ISKDC) is primarily based on the presence and number of affected glomeruli (mesangial proliferation, cellular crescents). The updated Oxford classification, which emphasizes tubular atrophy and interstitial fibrosis, is also used to group pathological features of IgAV-N. Both classifications have limitations. What is New: • Medical treatment should not be postponed in patients with IgAV-N and NS until after biopsy, as NS at diagnosis is associated with initial histological severity and poorer kidney outcome. This proposal needs to be verified in further studies. • Endocapillary proliferation is associated with the initial severity of IgAV-N at diagnosis, while chronic glomerular changes and interstitial fibrosis are associated with poorer short- and medium-term kidney outcomes.
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27
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Sheth AP, Vivar KL, Wagner AM, Kruse LL. Henoch Schonlein purpura in pediatric patients with inflammatory bowel disease: A case series. Pediatr Dermatol 2021; 38:1389-1392. [PMID: 34561913 DOI: 10.1111/pde.14818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Retrospective chart review was conducted to identify the clinical features of Henoch Schonlein purpura (HSP) in five children with inflammatory bowel disease (IBD). All five children, four of which were on anti-TNF therapies, experienced the onset of HSP after their IBD diagnosis. HSP averaged 20.8 months in duration. The patients in our cohort, particularly those on anti-TNF therapy for inflammatory bowel disease, experienced chronic and recurrent courses of HSP.
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Affiliation(s)
- Anjani P Sheth
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Karina L Vivar
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Dermatology, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Annette M Wagner
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Dermatology, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Lacey L Kruse
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Dermatology, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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28
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IgA Vasculitis: Etiology, Treatment, Biomarkers and Epigenetic Changes. Int J Mol Sci 2021; 22:ijms22147538. [PMID: 34299162 PMCID: PMC8307949 DOI: 10.3390/ijms22147538] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 07/12/2021] [Indexed: 02/06/2023] Open
Abstract
IgA, previously called Henoch-Schönlein vasculitis, is an essential immune component that drives the host immune response to the external environment. As IgA has the unique characteristic of a flexible response to broad types of microorganisms, it sometimes causes an autoreactive response in the host human body. IgA vasculitis and related organ dysfunction are representative IgA-mediated autoimmune diseases; bacterial and viral infections often trigger IgA vasculitis. Recent drug developments and the presence of COVID-19 have revealed that these agents can also trigger IgA vasculitis. These findings provide a novel understanding of the pathogenesis of IgA vasculitis. In this review, we focus on the characteristics of IgA and symptoms of IgA vasculitis and other organ dysfunction. We also mention the therapeutic approach, biomarkers, novel triggers for IgA vasculitis, and epigenetic modifications in patients with IgA vasculitis.
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Streptococcal infection in childhood Henoch-Schönlein purpura: a 5-year retrospective study from a single tertiary medical center in China, 2015-2019. Pediatr Rheumatol Online J 2021; 19:79. [PMID: 34078391 PMCID: PMC8173722 DOI: 10.1186/s12969-021-00569-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 05/18/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The present study focuses on the associations of streptococcal infection with the clinical phenotypes, relapse/recurrence and renal involvement in Henoch-Schönlein purpura (HSP) children. METHODS Two thousand seventy-four Chinese children with HSP were recruited from January 2015 to December 2019. Patients' histories associated with HSP onset were obtained by interviews and questionnaires. Laboratory data of urine tests, blood sample and infectious agents were collected. Renal biopsy was performed by the percutaneous technique. RESULTS (1) Streptococcal infection was identified in 393 (18.9%) HSP patients, and served as the most frequent infectious trigger. (2) Among the 393 cases with streptococcal infection, 43.0% of them had arthritis/arthralgia, 32.1% had abdominal pain and 29.3% had renal involvement. (3) 26.1% of HSP patients relapsed or recurred more than 1 time within a 5-year observational period, and the relapse/recurrence rate in streptococcal infectious group was subjected to a 0.4-fold decrease as compared with the non-infectious group. (4) No significant differences in renal pathological damage were identified among the streptococcal infectious group, the other infectious group and the non-infectious group. CONCLUSIONS Streptococcal infection is the most frequent trigger for childhood HSP and does not aggravate renal pathological damage; the possible elimination of streptococcal infection helps relieve the relapse/recurrence of HSP.
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30
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Hematuria, spots, and abdominal pain. Eur J Gastroenterol Hepatol 2021; 33:455-456. [PMID: 33512844 DOI: 10.1097/meg.0000000000001996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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31
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Jia L, Wu J, Wei J, Du L, Wang P, Zhang Y, Yu Y, Wang X, Yang Y, Gao Y. Proteomic analysis of urine reveals biomarkers for the diagnosis and phenotyping of abdominal-type Henoch-Schonlein purpura. Transl Pediatr 2021; 10:510-524. [PMID: 33850810 PMCID: PMC8039785 DOI: 10.21037/tp-20-317] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Abdominal-type Henoch-Schonlein purpura (HSP) is a common refractory disease in children. Currently, no specific diagnostic biomarker is available for HSP. METHODS Children with abdominal type HSP were first diagnosed with three syndromes using Chinese traditional medicine. The urinary proteomes among the three syndromes of patients with abdominal type HSP and healthy controls were compared using two label-free proteomics quantifications, including data-dependent acquisition and data-independent acquisition. RESULTS For the comparison between patients with abdominal type HSP and healthy children, a total of 75 differential urinary proteins were identified by determining the overlap of the two experiments. The ingenuity pathway analysis (IPA) analysis showed that these differential proteins were correlated with the pathogenesis of abdominal type HSP. Of these, 37 proteins were distributed in 13 solid tissues as tissue-enriched proteins. Monitoring changes in these proteins might help us detect uncommon clinical manifestations of HSP. Patients with abdominal type HSP can be further distinguished into three syndromes based on the urine proteome. Finally, a panel of six urinary proteins (P25774, P09417, Q7Z5L0, P60900, P14550 and P09668) was constructed for both the diagnosis and phenotyping of abdominal type HSP. CONCLUSIONS Urinary protein biomarkers for the diagnosis and phenotyping of abdominal type HSP were identified, which will contribute to the personalized treatment of patients with abdominal type HSP.
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Affiliation(s)
- Lulu Jia
- Clinical Research Center, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jianqiang Wu
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jing Wei
- Department of Biochemistry and Molecular Biology, School of Life Sciences, Beijing Normal University, Gene Engineering Drug and Biotechnology Beijing Key Laboratory, Beijing, China
| | - Lina Du
- Department of Chinese Medicine, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Panpan Wang
- Department of Chinese Medicine, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yanju Zhang
- Clinical Research Center, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yuncui Yu
- Clinical Research Center, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Xiaoling Wang
- Clinical Research Center, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yan Yang
- Department of Chinese Medicine, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Youhe Gao
- Department of Biochemistry and Molecular Biology, School of Life Sciences, Beijing Normal University, Gene Engineering Drug and Biotechnology Beijing Key Laboratory, Beijing, China
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32
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Kang Z, Wu W, Xun M, Ding Y, Li Z. Henoch-Schönlein Purpura /IgA Vasculitis Complicated by Coronary Artery Aneurysm: A Case Report and Literature Review. Front Pediatr 2021; 9:781106. [PMID: 35186817 PMCID: PMC8850625 DOI: 10.3389/fped.2021.781106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/20/2021] [Indexed: 12/19/2022] Open
Abstract
Henoch-Schönlein purpura (HSP)/ IgA vasculitis (IgAV) is the most common form of systemic vasculitis in children and often involves the skin, gastrointestinal tract, joints, and kidneys, though cardiac involvement rarely occurs. We report on a 6-year-old male child with HSP/IgAV who had renal and cardiac involvement at the initial stage of the disease and in whom we found an extremely rare coronary artery aneurysm. After administration of glucocorticoid combined with mycophenolate mofetil, the renal involvement improved, but the coronary artery aneurysm remained. Pursuant to this case, we retrieved information on other cases of HSP/IgAV complicated with cardiac involvement from the PubMed database, and excluded cases of cardiac involvement accompanied by Kawasaki disease, polyarteritis nodosa, rheumatic fever, Takayasu arteritis, systemic lupus erythematosus, poststreptococcal glomerulonephritis, or sepsis. We then analyzed gender, age, cardiac involvement, renal involvement, treatment, and prognoses. To date, 24 cases of HSP/IgAV complicated with cardiac involvement have been reported. Among them, there were 22 male and 2 female patients, with the onset age ranging from 3 to 71 years old. A total of 10 children (including the child we examined) and 14 adults were identified, and 17 patients (70.8%) had HSP/IgAV complicated with renal involvement. The majority of patients were treated with glucocorticoid and/or immunosuppressants or biological agents, 4 patients died (16.7%), 8 patients were completely relieved (33.3%), and 3 patients had unknown prognoses. This article suggests that HSP/IgAV complicated with cardiac involvement may result in a poor prognosis and early treatment may therefore be essential. Our case revealed that glucocorticoid does not prevent the occurrence of renal and cardiac involvement in HSP/IgAV patients. If HSP/IgAV is complicated with coronary artery dilation, the therapeutic effect of glucocorticoid combined with immunosuppressants is not satisfactory, and early administration of biological agents or IVIG may be an effective therapeutic regimen.
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Affiliation(s)
- Zhijuan Kang
- Department of Nephrology, Rheumatology and Immunology, Hunan Children's Hospital, Changsha, China.,The School of Pediatrics, Hengyang Medical School, University of South China, Changsha, China
| | - Wentao Wu
- The School of Pediatrics, Hengyang Medical School, University of South China, Changsha, China
| | - Mai Xun
- Department of Nephrology, Rheumatology and Immunology, Hunan Children's Hospital, Changsha, China.,The School of Pediatrics, Hengyang Medical School, University of South China, Changsha, China
| | - Yunfeng Ding
- Department of Nephrology, Rheumatology and Immunology, Hunan Children's Hospital, Changsha, China.,The School of Pediatrics, Hengyang Medical School, University of South China, Changsha, China
| | - Zhihui Li
- Department of Nephrology, Rheumatology and Immunology, Hunan Children's Hospital, Changsha, China.,The School of Pediatrics, Hengyang Medical School, University of South China, Changsha, China
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33
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Gastrointestinal bleeding with joint pain. Acta Gastroenterol Belg 2021; 84:145-146. [PMID: 33639710 DOI: 10.51821/84.1.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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34
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Serum TNF- α Level Is Associated with Disease Severity in Adult Patients with Immunoglobulin A Vasculitis Nephritis. DISEASE MARKERS 2020; 2020:5514145. [PMID: 33299497 PMCID: PMC7710402 DOI: 10.1155/2020/5514145] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 11/08/2020] [Accepted: 11/17/2020] [Indexed: 11/18/2022]
Abstract
Background Tumor necrosis factor-α (TNF-α) is a proinflammatory factor involved in the pathogenesis of immunoglobulin A vasculitis (IgAV). The association between serum TNF-α and disease severity in adult patients with IgAV nephritis (IgAV-N) has been inadequately evaluated. Methods Serum TNF-α was measured by chemiluminescence immunoassay in 53 renal biopsy-proved IgAV-N patients, 53 healthy controls, and 53 IgA nephropathy (IgAN) patients. The correlations of clinicopathologic parameters of IgAV-N patients with serum TNF-α were analyzed. Results In this cross-sectional study, the median age of IgAV-N patients was 29 (25-37) years, and 67.9% were female. Serum TNF-α was significantly higher in the IgAV-N group than in the healthy group [7.4 (5.7-9.4) pg/mL vs. 5.9 (5.0, 7.1) pg/mL, P = 0.001], but comparable with sex, age, and estimated glomerular filtration rate (eGFR) grade-matched IgAN patients. Serum creatinine (P = 0.006) and serum cystatin C (P = 0.001) were positively correlated with serum TNF-α level, while albumin (P = 0.014) and eGFR (P = 0.021) were negatively correlated with serum TNF-α level. Multivariate linear regression analysis revealed that eGFR (P = 0.007) was an independent clinical predictor of serum TNF-α. Patients with higher pathological classification grade also had higher serum TNF-α. Conclusions Serum TNF-α is associated with renal function and the pathological classification of adult patients with IgAV-N. TNF-α is a potential biomarker for the assessment of IgAV-N severity.
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35
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Hui G, Cheng Z, Ran H, Ziwei W, Fang D. A Pooled Study of Angiotensin-Converting Enzyme Insertion/Deletion Gene Polymorphism in Relation to Risk, Pathology and Prognosis of Childhood Immunoglobulin A Vasculitis Nephritis. Biochem Genet 2020; 59:202-218. [PMID: 32980913 DOI: 10.1007/s10528-020-09999-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 09/18/2020] [Indexed: 11/30/2022]
Abstract
The angiotensin-converting enzyme (ACE) insertion/deletion (I/D) gene polymorphism has been inconsistently reported to be a risk factor for Childhood immunoglobulin A vasculitis (IgAV) nephritis. We comprehensively searched electronic databases as of Jan 2020. Nineteen studies with 1104 cases and 1589 controls were included. Sensitivity analyses based on different subgroups were performed. Further analyses were conducted for association of ACE polymorphism with disease severity and prognosis. Significant associations were found between ACE I/D polymorphism and childhood IgAV nephritis, with the strongest association in DD vs. II comparison (OR 1.72, 95% CI 1.21-2.46). Subgroup analyses generally showed significant results. Besides, ACE polymorphism was significantly associated with proteinuria (DD + DI vs. II: OR 2.22, 95% CI 1.14-4.33; DI + II vs. DD: OR 0.49, 95% CI 0.30-0.81) and worse prognosis (the strongest effect in DD + DI vs. II: OR 4.43, 95% CI 1.84-10.71) among children with IgAV nephritis. The ACE polymorphism seemed not to be associated with hematuria, hypertension, and renal pathology. This study suggested significant association of ACE gene polymorphism with the risk of IgAV nephritis in children. D allele in the ACE genotype could be a useful genetic marker to predict proteinuria and worse prognosis for childhood IgAV nephritis.
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Affiliation(s)
- Gao Hui
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, Anhui, China. .,MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei, 230032, Anhui, China.
| | - Zhang Cheng
- Anhui Provincial Cancer Institute, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, Anhui, China
| | - Hua Ran
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, Anhui, China
| | - Wang Ziwei
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, Anhui, China
| | - Deng Fang
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, Anhui, China. .,MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei, 230032, Anhui, China.
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36
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Al E'ed A. Henoch-Schönlein purpura in Saudi Arabia: characteristics and rare vital organ involvement. Minerva Pediatr (Torino) 2020; 73:363-370. [PMID: 32960004 DOI: 10.23736/s2724-5276.20.05962-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Henoch-Schönlein purpura (HSP) is the most common small vessel vasculitis in children with an annual incidence of between 10 and 30 per 100,000. It is an inflammation that affects many organs primarily in the skin, gastrointestinal (GI) tract, musculoskeletal, also vital organs like kidneys and lungs which may lead to chronic kidney disease and pulmonary hemorrhage. In this review, we are showing the characteristics of Saudi patients with HSP and the relation with preceding infections, gender, and seasonal variations in addition to the common and most severe systemic involvements. We found cases that were challenging to diagnose and others with unfortunate fetal complications.
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Affiliation(s)
- Ashwaq Al E'ed
- Department of Pediatrics, College of Medicine, Qassim University, Qassim, Saudi Arabia -
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37
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Demir S, Kaplan O, Celebier M, Sag E, Bilginer Y, Lay I, Ozen S. Predictive biomarkers of IgA vasculitis with nephritis by metabolomic analysis. Semin Arthritis Rheum 2020; 50:1238-1244. [PMID: 33065418 DOI: 10.1016/j.semarthrit.2020.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/05/2020] [Accepted: 09/09/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND IgA vasculitis (IgAV) is the most common vasculitis of childhood. Renal involvement defines late morbidity of the disease. A better understanding of the pathophysiology of the progression to kidney disease and predictive biomarkers are required for better management of IgAV and its nephritis (IgAVN). OBJECTIVES An untargeted metabolomics approach was performed to reveal the underlying molecular mechanism of disease pathogenesis and to define potential biomarkers from plasma samples from IgAV and IgAVN patients. METHODS Forty-five active IgAV patients (H) and six healthy controls (C) were enrolled in the study. Plasma samples were collected on the same day of diagnosis and before any immunosuppressive treatment was initiated. At the time of diagnosis and sample collection, none of the patients had renal involvement. We used Quadrupole Time of Flight Mass Spectrometry (Q-TOF LC/MS) to investigate the alterations in plasma metabolomic profiles. Three separate pools were created: healthy controls (group C), active IgAV patients who did not develop renal involvement (group H), and patients who developed IgAVN at follow up (group N). Peak picking, grouping, and comparison parts were performed via XCMS (https://xcmsonline.scripps.edu/) software. RESULTS At follow-up, IgAVN developed in 6 out of 45 IgAV patients. The median time of renal involvement development is 23 days (range 5-45 days). Of these, 3 had nephritic proteinuria, one had nephrotic proteinuria, and 2 had microscopic hematuria. There were no significant differences in gender, age, clinical manifestations, and laboratory findings between the six patients who developed renal involvement and those who did not. In multivariate analysis, there was no significant association between any of the defined demographic and clinical characteristics (male sex, gastrointestinal system involvement, joint involvement, CRP, WBC, PLT) and the occurrence of renal involvement. Totally 2618 peaks were detected for group H, N, and C. Among them, 355 peaks were found to be statistically significant and reliable (p<0.05), and 155 of these peaks were found to be changed (fold change >1.5) between the groups C and H, and 66 peaks were found to be changed (fold change >1.5) between the groups H and N. The number of the peaks on the intersection of the peaks found to be different between the groups (C and H) and (H and N) was 39. Based on putative identification results, 15 putatively identified metabolites matched with 11 peaks were presented as biomarker candidates after careful evaluation with a clinical perspective. CONCLUSION We suggest that DHAP (18:0), prostaglandin D2/I2, porphobilinogen, 5-methyltetrahydrofolic acid, and N-Acetyl-4-O-acetylneuraminic acid/N-Acetyl-7-O-acetylneuraminic acid may serve as biomarkers for predicting kidney disease. Future studies with larger groups of IgAV patients are needed to validate the identified metabolic profile.
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Affiliation(s)
- Selcan Demir
- Hacettepe University Faculty of Medicine, Department of Pediatric Rheumatology, Ankara, Turkey
| | - Ozan Kaplan
- Hacettepe University, Faculty of Pharmacy, Department of Analytical Chemistry, Ankara, Turkey; Hacettepe University, Faculty of Pharmacy Drug and Cosmetic R&D and Quality Control Laboratory (HUNIKAL), Ankara, Turkey
| | - Mustafa Celebier
- Hacettepe University, Faculty of Pharmacy, Department of Analytical Chemistry, Ankara, Turkey; Hacettepe University, Faculty of Pharmacy Drug and Cosmetic R&D and Quality Control Laboratory (HUNIKAL), Ankara, Turkey
| | - Erdal Sag
- Hacettepe University Faculty of Medicine, Department of Pediatric Rheumatology, Ankara, Turkey
| | - Yelda Bilginer
- Hacettepe University Faculty of Medicine, Department of Pediatric Rheumatology, Ankara, Turkey
| | - Incilay Lay
- Hacettepe University Faculty of Medicine, Department of Medical Biochemistry, Ankara, Turkey; Hacettepe University Hospitals, Clinical Pathology Laboratory, Ankara, Turkey
| | - Seza Ozen
- Hacettepe University Faculty of Medicine, Department of Pediatric Rheumatology, Ankara, Turkey.
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Yu B, Shi S, Hou W, Liu L, Lv J, Wang S, Zhang H. Evaluation of the Oxford classification in immunoglobulin A vasculitis with nephritis: a cohort study and meta-analysis. Clin Kidney J 2020; 14:516-525. [PMID: 33623674 PMCID: PMC7886544 DOI: 10.1093/ckj/sfaa129] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Indexed: 12/21/2022] Open
Abstract
Background Similarities in clinicopathological presentations in immunoglobulin A (IgA) nephropathy and IgA vasculitis with nephritis (IgAVN) raise the question of the utility of the Oxford classification in the latter. The aim of this study was to evaluate the Oxford classification in IgAVN. Methods We conducted a retrospective cohort study and meta-analysis following systematic searching of the MEDLINE and Excerpta Medica Database (EMBASE) databases between January 2009 and September 2019. We modeled the association of 30 and 50% decline in estimated glomerular filtration rate or end-stage renal disease with pathologic lesions of the Oxford classification including mesangial hypercellularity (M), endocapillary hypercellularity (E), segmental glomerulosclerosis (S), interstitial fibrosis/tubular atrophy (T) and crescents (C). Results were pooled using random-effects meta-analysis. Results The cohort study included 132 patients, and only T lesion was an independently risk factor in IgAVN. The meta-analysis yielded six retrospective studies with 721 patients and 139 endpoints. In multivariate model, T lesion was significantly associated with renal outcome (hazard ratio = 2.45, P = 0.007). M and C lesions could not predict renal outcome without evidence of heterogeneity. E and S lesions could not predict renal outcome with evidence of heterogeneity (I 2 = 66.6%; P = 0.01, and I 2 = 65.8%; P = 0.03, respectively). Subgroup analysis showed that the possible reasons to the heterogeneity were from usage of immunosuppressant, sample size and follow-up time. Conclusions The study suggests that the Oxford classification could not be fully validated in IgAVN. Higher portion of immunosuppressant especially before renal biopsy might be the main confounder for the predictive value of Oxford classification in IgAVN.
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Affiliation(s)
- Bingxin Yu
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
| | - Sufang Shi
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
| | - Wanyin Hou
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
| | - Lijun Liu
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
| | - Jicheng Lv
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
| | - Suxia Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Electron Microscopy Laboratory, Peking University First Hospital, Beijing, China
| | - Hong Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
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An Integrated Transcriptomic and Proteomic Analysis Identifies Significant Novel Pathways for Henoch-Schönlein Purpura Nephritis Progression. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2489175. [PMID: 32685455 PMCID: PMC7322592 DOI: 10.1155/2020/2489175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/11/2020] [Accepted: 04/28/2020] [Indexed: 02/04/2023]
Abstract
Background Although Henoch-Schönlein purpura nephritis (HSPN) is characterized by glomerular deposition of aberrantly glycosylated immunoglobulin A1 (IgA1), the underlying mechanism of HSPN progression has not yet been completely elucidated. In this study, we integrated transcriptomic and proteomic analyses to explore the underlying mechanism of HSPN progression. Methods RNA sequencing and tandem mass tag- (TMT-) based quantitative proteomics were used to gain serum transcriptomic and proteomic profiles of patients with different types of HSPN (3 × type 1, 3 × type 2, and 3 × type 3). Student's t-tests were performed to obtain the significance of the differential gene expression. The clusterProfiler package was used to conduct the functional annotation of the DEGs for both Gene Ontology terms and Kyoto Encyclopedia of Genes and Genomes pathways. Results A total of 2315 mRNAs and 30 proteins were differentially expressed between the different types of HSPN. 58 mRNAs and one protein changed continuously during HSPN development and are potential biomarkers for HSPN progression. The validation cohort (another 9 patients) confirmed the high-throughput results of the transcriptomic and proteomic analyses. A total of 385 significant pathways were related to HSPN progression, and four of them were closely related to clinical biochemical indicators and may play an important role in the progression of HSPN. Those pathways reveal that HSPN progression may be related to the inhibition of inflammation, promotion of apoptosis, and repair of renal injury. Conclusions Four pathways were found to be closely related to HSPN progression, and it seems that HSPN progression is mainly due to the inhibition of inflammation, promotion of apoptosis, and repair of renal injury.
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Du L, Wang P, Liu C, Li S, Yue S, Yang Y. Multisystemic manifestations of IgA vasculitis. Clin Rheumatol 2020; 40:43-52. [PMID: 32557258 DOI: 10.1007/s10067-020-05166-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 01/27/2023]
Abstract
Immunoglobulin A vasculitis (IgAV), also known as Henoch-Schönlein Purpura, is one of the most common kind of systemic vasculitis in children, and due to the involvement of small blood vessels throughout the body, this disease can cause a variety of symptoms in different organs. Our aim was to review the data on various systemic manifestations of IgAV. A research of the literature was performed in PubMed database, utilizing the MeSH terms "IgA vasculitis" and "Henoch Schönlein Purpura". According to the predetermined structure of the manuscript, we extracted and sorted out the relevant data. Clinically, almost all the patients will present with palpable skin purpura, together with arthritis, gastrointestinal tract involvement, or kidney damage. Other rare systemic manifestations include neurological symptoms, scrotal involvement, and cardiopulmonary disease. When uncommon complications occur, patients may be misdiagnosed as other diseases, thus delaying treatment. Although the course of IgAV is mostly self-limited, misdiagnosis can also lead to a poor prognosis. A comprehensive awareness to the clinical manifestations of IgAV is the necessary prerequisite for its timely diagnosis. Prompt diagnosis and adequate treatment are essential for optimal results.
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Affiliation(s)
- Lina Du
- Department of Chinese Medicine, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi Road, Beijing, 100045, China
| | - Panpan Wang
- Department of Chinese Medicine, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi Road, Beijing, 100045, China
| | - Chang Liu
- Department of Chinese Medicine, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi Road, Beijing, 100045, China
| | - Shaojing Li
- Department of Chinese Medicine, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi Road, Beijing, 100045, China
| | - Shuang Yue
- Department of Chinese Medicine, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi Road, Beijing, 100045, China
| | - Yan Yang
- Department of Chinese Medicine, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi Road, Beijing, 100045, China.
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Zheng X, Chen Q, Chen L. Obesity is associated with Henoch-Schönlein Purpura Nephritis and development of end-stage renal disease in children. Ren Fail 2020; 41:1016-1020. [PMID: 31735105 PMCID: PMC6882475 DOI: 10.1080/0886022x.2019.1685545] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Objectives: To explore the association of obesity with the occurrence of Henoch-Schönlein Purpura Nephritis (HSPN) and development of end-stage renal disease (ESRD) in children with Henoch-Schönlein Purpura (HSP). Methods: This was a retrospective study of 446 pediatric patients with diagnosed HSP. All patients’ demographic characteristics, clinical features, and laboratory data were collected from the electronic medical records in hospitals from January 2008 to December 2014, and the prognosis was followed up till December 2018. Multivariate logistic regression and the Cox proportional hazard regression were employed for exploring the potential risk factors for occurrence of HSPN and development of ESRD, respectively. Results: It is reported that 35.2% (n = 157) of HSP patients had HSPN. The multivariate logistic regression showed that obesity (OR = 3.82; 95% CI: 1.92–7.49; p < .01), age over 6 years old at onset (OR = 2.24; 95% CI: 1.32–4.87; p < .01) and angioedema (OR = 1.72; 95% CI: 1.25–4.02; p < .01) were significantly associated with the occurrence of HSPN. During a median follow-up of 52.0 months, 5.2% (n = 23) of HSP patients developed ESRD. The Cox proportional hazard regression indicated that obesity (HR = 3.27; 95% CI: 2.01–6.37; p < .01) and International Study of Kidney Disease of Children (ISKDC) III (HR= 2.88; 95% CI: 1.96–3.80; p < .01) were predictors for the development of ESRD in patients with HSP. Conclusions: Obesity is associated with an increased risk of renal involvement and contributes to the development of ESRD in pediatric patients with HSP.
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Affiliation(s)
- Xin Zheng
- Department of Pediatrics, Fujian Provincial Hospital, Fujian Medical University Shengli Clinical Medical College, Fuzhou, China
| | - Qiaobin Chen
- Department of Pediatrics, Fujian Provincial Hospital, Fujian Medical University Shengli Clinical Medical College, Fuzhou, China
| | - Lang Chen
- Department of Pediatrics, Fujian Provincial Hospital, Fujian Medical University Shengli Clinical Medical College, Fuzhou, China
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Kriti M, Swathi C, Ajay B, Balram JO. Henoch-Schonlein Purpura with multiple renal calculi with hydronephrosis-A Case Report. OPEN JOURNAL OF TROPICAL MEDICINE 2020. [DOI: 10.17352/ojtm.000012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Gökçe Ş, Kurugöl Z, Koturoğlu G, Aslan A. Predictive role of laboratory markers and clinical features for recurrent Henoch-Schönlein Purpura in childhood: A study from Turkey. Mod Rheumatol 2020; 30:1047-1052. [PMID: 31711347 DOI: 10.1080/14397595.2019.1690966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objectives: Henoch Schönlein Purpura is the most common systemic vasculitis of the childhood. The objective of this study was to evaluate whether there is a clinical significance of laboratory parameters and clinical features on the prediction of the recurrent Henoch Schönlein Purpura in children.Methods: For recurrent Henoch Schönlein Purpura, several laboratory results and clinical features were examined to identify the predictor factors via the logistic regression model in 99 children with Henoch Schönlein Purpura. A p-value of <.05 was considered significant. The patients were divided into two groups as the first attack and the recurrent.Results: The demographic features and laboratory results were not found statistically significant between the two groups (p > .05). The multiple logistic regression model showed that the risk of recurrent Henoch Schönlein Purpura increased 17.2-fold in children with Henoch Schönlein Purpura affected by the four systems including skin, joint, kidney and gastrointestinal system [Odds Ratio (OR) 17.2, 95% CI 1.4-12; p < .001].Conclusion: In our inpatient population, the laboratory characteristics were detected not to be a factor for the prediction of recurrence. However, the four systems including skin, joint, kidney and gastrointestinal involvement may be used as a predictive factor for recurrent HSP.
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Affiliation(s)
- Şule Gökçe
- Ege University Faculty of Medicine, Department of Pediatrics, General Pediatrics Unit, Ege University, Bornova, Turkey
| | - Zafer Kurugöl
- Ege University Faculty of Medicine, Department of Pediatrics, General Pediatrics Unit, Ege University, Bornova, Turkey
| | - Güldane Koturoğlu
- Ege University Faculty of Medicine, Department of Pediatrics, General Pediatrics Unit, Ege University, Bornova, Turkey
| | - Aslı Aslan
- Ege University Faculty of Medicine, Department of Pediatrics, General Pediatrics Unit, Ege University, Bornova, Turkey
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Yu Y, Chen J, Yin H, Deng Z, Xie Y, Yuan Q, Xu H, Liu S, Tao L, Peng Z. Efficacy of steroid and immunosuppressant combined therapy in Chinese patients with Henoch-Schönlein purpura nephritis: A retrospective study. Int Immunopharmacol 2020; 81:106229. [PMID: 32014710 DOI: 10.1016/j.intimp.2020.106229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/17/2020] [Accepted: 01/18/2020] [Indexed: 01/15/2023]
Abstract
/y) and proteinuria were measured. The primary outcome progression was analyzed using Kaplan-Meier survival curves. The effect of the combined therapy on renal outcome was analyzed by multivariable Cox regression. Propensity score matching and sensitivity analysis were used to explore whether pathological features impacted prognosis. Patients who received combined steroid and immunosuppressant therapy were more likely to recover from HSPN and had proteinuria <3 g/24 h (P = 0.02) or 1 g/24 h (P = 0.03). Multiple Cox regression analysis confirmed that this decrease was independent of renin-angiotensin system blockers. Further sensitivity analysis showed that combined therapy was effective in patients with crescents (P = 0.02). However, combined steroid and immunosuppressant therapy was not more effective in patients with endocapillary hypercellularity (E), tubular atrophy/interstitial fibrosis (T), or segmental sclerosis (S). Combined steroid and immunosuppressant therapy was significantly associated with HSPN remission, and more effectively decreased proteinuria during the initial disease phase.
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Affiliation(s)
- Yue Yu
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Jingjing Chen
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Hongling Yin
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Zhenghao Deng
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.
| | - Yanyun Xie
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.
| | - Qiongjing Yuan
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.
| | - Hui Xu
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.
| | - Shao Liu
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Lijian Tao
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.
| | - Zhangzhe Peng
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.
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Kopparapu A, Jarrett D, Kraleti S. IgA vasculitis presenting as abdominal pain and rash. Proc (Bayl Univ Med Cent) 2019; 32:599-600. [DOI: 10.1080/08998280.2019.1629229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/03/2019] [Accepted: 06/05/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- Anil Kopparapu
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Diane Jarrett
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Shashank Kraleti
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Berthelot L, Jamin A, Viglietti D, Chemouny JM, Ayari H, Pierre M, Housset P, Sauvaget V, Hurtado-Nedelec M, Vrtovsnik F, Daugas E, Monteiro RC, Pillebout E. Value of biomarkers for predicting immunoglobulin A vasculitis nephritis outcome in an adult prospective cohort. Nephrol Dial Transplant 2019; 33:1579-1590. [PMID: 29126311 DOI: 10.1093/ndt/gfx300] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 09/11/2017] [Indexed: 11/12/2022] Open
Abstract
Background Henoch-Schönlein purpura, more recently renamed immunoglobulin A vasculitis (IgAV), is a systemic vasculitis characterized by IgA deposits. The current markers used to assess IgAV inaccurately evaluate the risk of nephritis occurrence and its long-term outcomes. The current study assessed biomarkers of nephritis outcomes. Methods This French multicentre prospective study enrolled 85 adult patients at the time of disease onset. Patients were assessed for clinical and biological parameters and re-examined after 1 year. Immunoglobulins, cytokines, IgA glycosylation, IgA complexes and neutrophil gelatinase-associated lipocalin (NGAL) concentrations were assessed in blood and urine. Results We identified 60 patients with IgAV-related nephritis (IgAV-N) and 25 patients without nephritis (IgAV-woN). At the time of inclusion (Day 1), the serum levels of galactose-deficient IgA1 (Gd-IgA1) and urinary concentrations of IgA, IgG, IgM, NGAL, interleukin (IL)-1β, IL-6, IL-8, IL-10, IgA-IgG and IgA-sCD89 complexes were higher in the IgAV-N patients than in the IgAV-woN patients (P < 0.005 for all comparisons). After follow-up (1 year), 22 patients showed a poor outcome. Among the tested markers, urine IgA at disease onset adequately reclassified the risk of poor outcome over conventional clinical factors, including estimated glomerular filtration rate, proteinuria and age (continuous net reclassification improvement = 0.72, P = 0.001; integrated discrimination improvement = 0.13, P = 0.009) in IgAV patients. Conclusions Taken together, these results showed that serum Gd-IgA1 and urinary IgA, IgG, IgM, NGAL, IL-1β, IL-6, IL-8, IL-10, IgA-IgG and IgA-sCD89 complexes were associated with nephritis in IgAV patients. Urinary IgA level may improve patient risk stratification for poor outcome.
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Affiliation(s)
- Laureline Berthelot
- INSERM 1149, Center of Research on Inflammation, Paris, France.,Inflamex, Laboratory of Excellence, Bichat Medical Faculty, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,CNRS ERL8252, Paris, France
| | - Agnès Jamin
- INSERM 1149, Center of Research on Inflammation, Paris, France.,Inflamex, Laboratory of Excellence, Bichat Medical Faculty, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,CNRS ERL8252, Paris, France
| | - Denis Viglietti
- Department of Nephrology, Saint-Louis Hospital, AP-HP, Paris, France
| | - Jonathan M Chemouny
- INSERM 1149, Center of Research on Inflammation, Paris, France.,Inflamex, Laboratory of Excellence, Bichat Medical Faculty, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,CNRS ERL8252, Paris, France.,Department of Nephrology, Bichat Hospital, DHU Fire, AP-HP, Paris, France
| | - Hamza Ayari
- INSERM 1149, Center of Research on Inflammation, Paris, France.,Inflamex, Laboratory of Excellence, Bichat Medical Faculty, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,CNRS ERL8252, Paris, France
| | - Melissa Pierre
- INSERM 1149, Center of Research on Inflammation, Paris, France.,Inflamex, Laboratory of Excellence, Bichat Medical Faculty, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,CNRS ERL8252, Paris, France
| | - Pierre Housset
- INSERM 1149, Center of Research on Inflammation, Paris, France.,Inflamex, Laboratory of Excellence, Bichat Medical Faculty, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,CNRS ERL8252, Paris, France
| | - Virginia Sauvaget
- INSERM 1149, Center of Research on Inflammation, Paris, France.,Inflamex, Laboratory of Excellence, Bichat Medical Faculty, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,CNRS ERL8252, Paris, France
| | - Margarita Hurtado-Nedelec
- INSERM 1149, Center of Research on Inflammation, Paris, France.,Inflamex, Laboratory of Excellence, Bichat Medical Faculty, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,CNRS ERL8252, Paris, France.,Department of Immunology, Bichat Hospital, AP-HP, Paris, France
| | - François Vrtovsnik
- INSERM 1149, Center of Research on Inflammation, Paris, France.,Inflamex, Laboratory of Excellence, Bichat Medical Faculty, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,CNRS ERL8252, Paris, France.,Department of Nephrology, Bichat Hospital, DHU Fire, AP-HP, Paris, France
| | - Eric Daugas
- INSERM 1149, Center of Research on Inflammation, Paris, France.,Inflamex, Laboratory of Excellence, Bichat Medical Faculty, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,CNRS ERL8252, Paris, France.,Department of Nephrology, Bichat Hospital, DHU Fire, AP-HP, Paris, France
| | | | - Renato C Monteiro
- INSERM 1149, Center of Research on Inflammation, Paris, France.,Inflamex, Laboratory of Excellence, Bichat Medical Faculty, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,CNRS ERL8252, Paris, France.,Department of Immunology, Bichat Hospital, AP-HP, Paris, France
| | - Evangeline Pillebout
- INSERM 1149, Center of Research on Inflammation, Paris, France.,Inflamex, Laboratory of Excellence, Bichat Medical Faculty, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,CNRS ERL8252, Paris, France.,Department of Nephrology, Saint-Louis Hospital, AP-HP, Paris, France
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Wilkinson A. Early recognition and treatment of Henoch-Schönlein purpura in children. Nurs Child Young People 2019; 31:36-40. [PMID: 31486599 DOI: 10.7748/ncyp.2019.e1118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2019] [Indexed: 06/10/2023]
Abstract
Henoch-Schönlein purpura (HSP) is characterised by a non-blanching rash, which commonly affects the lower limbs of children aged 3-15 years. It is the most common vasculitis in children. HSP often develops after an upper respiratory tract infection and is more likely to present in autumn, winter and spring. The majority of cases resolve with symptomatic treatment although some cases may progress to serious complications, including renal involvement. A case study is presented and differential diagnoses are explored. The pathophysiology of HSP is discussed. Nurses are often the first to assess patients so they are in an ideal position to recognise and treat HSP early on. Admission of a child into hospital is a stressful event for the parents and child; the nurse can help by ensuring prompt admission to hospital and offering support and reassurance to the family.
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Koskela M, Jahnukainen T, Endén K, Arikoski P, Kataja J, Nuutinen M, Ylinen E. Methylprednisolone or cyclosporine a in the treatment of Henoch-Schönlein nephritis: a nationwide study. Pediatr Nephrol 2019; 34:1447-1456. [PMID: 30955086 DOI: 10.1007/s00467-019-04238-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/10/2019] [Accepted: 03/14/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Optimal treatment of Henoch-Schönlein purpura nephritis (HSN) remains unclear. We evaluated outcome of pediatric HSN patients treated initially with either methylprednisolone (MP) or cyclosporine A (CyA) in Finland between 1996 and 2011. METHODS Outcome of 62 HSN patients was evaluated by screening urine and blood samples (n = 51) or by collecting clinical parameters from medical charts until last follow-up visit (n = 11). Sixty (97%) patients had nephrotic-range proteinuria and/or ISKDC grade ≥ III before initial treatment. Patients were initially treated with either MP pulses (n = 42) followed by oral prednisone or with CyA (n = 20). Fifty-nine (95%) patients received angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers. RESULTS Mean follow-up time was 10.8 years (range 3.2-21.2 years). One patient developed end-stage renal disease and another had decreased renal function (eGFR < 60 mL/min/1.73m2), both initially treated with MP (3%). Six patients (5 MP, 1 CyA) had eGFR between 60 and 89 mL/min/1.73m2 (10%). Eighteen patients (13 MP, 5 CyA) had proteinuria and/or hematuria (29%) and four of them had proteinuria > 0.5 g/day at end of follow-up. Sixteen (38%) MP-treated and two (10%) CyA-treated patients needed additional immunosuppressive treatment (RR 3.81, 95% CI 1.16-14.3, p = 0.035). Late initiation of treatment was associated with an increased risk for persistent proteinuria. CONCLUSIONS Long-term outcome was relatively good in both treatment groups. However, since urinary abnormalities may persist or develop, long-term follow-up of HSN patients is mandatory. Early initiation of treatment had a favorable effect on proteinuria.
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Affiliation(s)
- Mikael Koskela
- Children's Hospital, Pediatric Research Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland. .,Department of Pediatric Nephrology and Transplantation, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, 00290, Helsinki, Finland.
| | - Timo Jahnukainen
- Department of Pediatric Nephrology and Transplantation, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, 00290, Helsinki, Finland
| | - Kira Endén
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
| | - Pekka Arikoski
- Department of Pediatrics, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Janne Kataja
- Pediatric and Adolescent Medicine, Turku University Hospital, Turku, Finland
| | - Matti Nuutinen
- Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit, Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Medical Research Center Oulu (MRC Oulu), Oulu, Finland
| | - Elisa Ylinen
- Department of Pediatric Nephrology and Transplantation, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, 00290, Helsinki, Finland
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Roman C, Dima B, Muyshont L, Schurmans T, Gilliaux O. Indications and efficiency of dapsone in IgA vasculitis (Henoch-Schonlein purpura): case series and a review of the literature. Eur J Pediatr 2019; 178:1275-1281. [PMID: 31230197 DOI: 10.1007/s00431-019-03409-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/06/2019] [Accepted: 06/09/2019] [Indexed: 01/09/2023]
Abstract
Immunoglobulin A (IgA) vasculitis (Henoch-Schonlein purpura (HSP)) is the most common vasculitis in children. It is characterized by purpuric rash, arthritis, gastrointestinal, and/or renal involvement. Spontaneous resolution is the typical outcome. In chronic cutaneous manifestations of IgA vasculitis, dapsone seems to show a good effectiveness. Multiple case reports and case series about dapsone in chronic IgA vasculitis are available. However, no clear evaluation of its indications, its effectiveness, or its usage guidelines (optimal dosage or duration of treatment) is available. We reviewed the published cases of IgA vasculitis treated by dapsone and compared them with 2 similar cases that we encountered. Seventeen patients (ranging from 22 months old to 16 years old) with severe or persistent clinical signs of IgA vasculitis were included. Dapsone showed good results on the resolution of cutaneous lesions but not on renal manifestations. Complications (methemoglobinemia) were observed on 1 patient. Half of the patients relapsed after treatment discontinuation. The difference between the time lapse before initiation and the duration of the treatment was not significant.Conclusion: We suggest that dapsone can have a positive effect in chronic IgA vasculitis when cutaneous manifestations last more than 6 weeks at the dosage of 1-2 mg/kg once per day during 1 week. What is Known: • IgA vasculitis or Henoch-Schonlein purpura is the most common vasculitis in children and affects mostly small vessels of the skin, kidney, and gastrointestinal tract. It resolves spontaneously in most of the cases. Exceptionally, cutaneous lesions can last several weeks. • Dapsone is a bacteriostatic antibacterial sulfonamide drug found to be effective in the treatment of some inflammatory dermatological diseases like IgA vasculitis. What is New: • Dapsone is effective against chronic purpuric lesion (> 6 weeks) at the minimal dose of 1 mg/kg/day. • Relapse occurs frequently after discontinuation but responds after a second course of treatment. A longer duration of treatment or a delay in treatment by dapsone does not seem to influence the relapse rate.
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Affiliation(s)
- Céline Roman
- Department of Pediatrics, Hôpital Civil Marie Curie, CHU of Charleroi, 140 Chaussée de Bruxelles, 6042, Charleroi (Lodelinsart), Belgium
| | - Bogdan Dima
- Department of Pediatrics, Hôpital Civil Marie Curie, CHU of Charleroi, 140 Chaussée de Bruxelles, 6042, Charleroi (Lodelinsart), Belgium.,Pediatric Department, Cliniques de l'Europe Sainte-Elisabeth, 206 Avenue de Frélaan, 1180, Brussels, Belgium
| | - Laurence Muyshont
- Department of Pediatrics, Hôpital Civil Marie Curie, CHU of Charleroi, 140 Chaussée de Bruxelles, 6042, Charleroi (Lodelinsart), Belgium
| | - Thierry Schurmans
- Department of Pediatrics, Hôpital Civil Marie Curie, CHU of Charleroi, 140 Chaussée de Bruxelles, 6042, Charleroi (Lodelinsart), Belgium
| | - Olivier Gilliaux
- Department of Pediatrics, Hôpital Civil Marie Curie, CHU of Charleroi, 140 Chaussée de Bruxelles, 6042, Charleroi (Lodelinsart), Belgium.
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Gweon T, Kwon J. Rapid progression and recovery of massive gastric mucosal damage complicated by Henoch‑Sch�nlein purpura in a patient with liver cirrhosis: A case report. Exp Ther Med 2019; 18:2051-2054. [PMID: 31452703 PMCID: PMC6704504 DOI: 10.3892/etm.2019.7815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 07/05/2019] [Indexed: 11/18/2022] Open
Abstract
Endoscopic findings associated with gastric ischemia include friable gastric mucosa, irregular ulceration, petechiae and purpura. The etiology of gastric ischemia includes shock, sepsis, thrombosis, embolism and vasculitis. Henoch-Schönlein purpura (HSP) is a leukocytoclastic vasculitis that affects small vessels in the skin, kidney and gastrointestinal (GI) tract. Rapid progression of HSP manifested with acute gastric mucosal bleeding has been rarely reported. The present case study reports on a patient who had undergone endoscopic variceal ligation for esophageal varix bleeding and the gastric mucosa exhibited no evidence of HSP. After 9 days, reexamination using endoscopy to check for new-onset hematemesis revealed massive necrosis in the gastric mucosa, friable mucosal tissue and acute ischemic GI bleeding. The patient was treated with corticosteroid injections for 7 days, which caused a marked regression of the hemorrhagic gastric mucosa. The present case study reported on this patient with acute GI bleeding caused by HSP who was successfully treated with corticosteroids.
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Affiliation(s)
- Tae‑Geun Gweon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon 21431, Republic of Korea
| | - Jung Kwon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon 21431, Republic of Korea
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