Clinical and pathological features and prognosis of 341 children with henoch schonlein purpura nephritis were studied based on Oxford pathological classification

Abstract

(1) Background: To investigate the application value of Oxford pathological classification in children with henoch schonlein purpura nephritis (HSPN); (2) Methods: The clinical and pathological data of 341 children with HSPN diagnosed by renal biopsy at the First Affiliated Hospital of Henan University of Traditional Chinese Medicine from January 2015 to December 2017 were retrospectively analysed. Renal pathology was reevaluated and grouped according to the MEST-C score. Therefore, the tubulointerstitial lesions were divided into acute (Ta) and chronic (Tc) groups, M0/M1, E0/E1, S0/S1, Ta0/Ta1, Tc0/Tc1, and C0/C1/C2. The clinical, pathological and prognostic characteristics of the children were analysed by SPSS 23.0; (3) Results: (1) A total of 341 children were included, with a male to female ratio of 1.27:1, a median age of onset of 9 (8,11) years, and 10 (3,21) days between the first symptom and the onset of abnormal urine. (2) Haematuria and proteinuria were the most common clinical subtypes, the proportion of haematuria and proteinuria type was higher in the C1 group, the proportion of nephrotic syndrome type was higher in the M1, E1 and Ta1 groups, and the proportion of chronic nephritis type was higher in the S1 and Tc1 groups (P < 0.05); M1, Ta1, and C2 were associated with more severe microscopic haematuria, and M1, E1, Ta1, and C2 were associated with greater proteinuria (P < 0.05); M1, Ta1 and C1/C2 were associated with the decrease of eGFR and the increase of Scr; M1, E1 and Ta1 were associated with the decrease of ALB, and M1 and C2 were associated with the increase of BUN (P < 0.05). (3) Ⅲ and Ⅱ were the most common pathological changes in ISKDC classification, and there were no Ⅰ, Ⅴ and Ⅵ grade cases; the pathological changes of E1 and C1 were more common with MEST-C score; MEST-C score and ISKDC classification had certain relevance: M1, E1, Ta1 and C2/C1 were more severe in terms of ISKDC classification, and the S1 and Tc1 groups were less severe. (4) In ISKDC grading, IIb had a better prognosis, while IV had a relatively poor prognosis (P < 0.05); Tc1 and C2 were independent prognostic risk factors in the MEST-C score (P < 0.05); (4) Conclusions: (1) The pathological indices of MEST-C were correlated with clinical classification: the proportion of nephrotic syndrome was higher in the M1, E1, and Ta1 groups and chronic glomerulonephritis type in the S1 and Tc1 groups, the pathological changes of M1, Ta1 and C1/C2 were related to the decrease of microscopic haematuria, the level of eGFR and the increase of Scr, and M1, E1, Ta1 and C1/C2 were related to massive proteinuria. (2) All pathological indices of MEST-C were correlated with ISKDC grade; ISKDC grade in the S1 and Tc1 groups was lower than that in the S0 and Tc0 groups; Ta1 lesions were related to C3 deposition intensity; there was a significant difference in prognosis between grade Ⅱ b and grade Ⅳ; M1, Ta1, Tc1 and C2 had relatively poor prognosis, and Tc1 and C2 were related to poor renal prognosis and were independent risk factors for renal prognosis. (3) There is a significant correlation between the MEST-C score and clinical manifestations and laboratory indices of HSPN in children, which can predict the prognosis of the kidney in children with HSPN.