Henoch-Schönlein purpura nephritis: initial risk factors and outcomes in a Latin American tertiary center

Buscatti, Izabel M.; Casella, Beatriz Borba; Aikawa, Nádia E.; Watanabe, Andréa; Farhat, Sylvia Costa Lima; Campos, Lúcia Maria Arruda; Silva, Clóvis A.

doi:10.1007/s10067-017-3972-3

Cited by 46 publications

(55 citation statements)

References 35 publications

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“…Shrestha et al 35 observed a similar increasing incidence of hematuria after diagnosis in their cohort of 37 adult-onset IgAV patients with hematuria from 46% of patients at baseline and to more than 66% at last visit. In a study of 322 children and adolescents with IgAV, Buscatti et al 36 reported that among those without nephritis in the first 3 months, 28% had development of renal involvement during follow-up. These findings of lateronset renal involvement suggest that active surveillance is necessary to identify patients with delayed renal pathology from IgAV.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics of Biopsy-Proven IgA Vasculitis in Children and Adults: A Retrospective Cohort Study

Villatoro-Villar

Crowson

Warrington

et al. 2019

Mayo Clinic Proceedings

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Objective: To describe the differences in clinical characteristics and outcome between adult-and childhood-onset biopsy-proven IgA vasculitis (IgAV) in North America. Patients and Methods: Patients with IgAV diagnosed from January 1, 1997, through December 31, 2016, were retrospectively identified. Data were abstracted from direct medical record review. Kaplan-Meier methods were used to estimate survival rates. Results: A total of 243 patients with IgAV were included (227 [93.4%] white, 141 [58.0%] male); 174 patients were adults (!21 years), and 69 were younger than 21 years. Compared with patients younger than 21 years, adults at baseline more frequently had ulcerative skin lesions (19 [10.9%] vs 1 [1.4%]; P¼.02) and nephrotic-range proteinuria (21 of 96 [21.9%] vs 1 of 38 [2.6%]; P¼.007) but less commonly had abdominal pain (59 [33.9%] vs 42 [60.9%]; P<.001), ischemic gastrointestinal tract involvement (18 [10.3%] vs 14 [20.3%]; P¼.04), and arthralgias (66 [37.9%] vs 42 [60.8%]; P<.001). During 389 person-years of follow-up, 29 deaths were observed. Five-year survival rates for patients aged younger than 21, 21 to 50, and 51 years or older were 100%, 94%, and 40%, respectively. In comparison to data from the United States life tables for whites, patients 51 years or older at diagnosis had a greater than 7-fold increased risk of mortality (standardized mortality, 7.60 [95% CI, 5.01-11.06]; P<.001). Conclusion: IgA vasculitis in adults is associated with more severe skin/kidney involvement and poorer renal outcome. Among adults with IgAV, patients aged 51 years or older at diagnosis have significantly higher mortality (P<.001).

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Section: Discussionmentioning

confidence: 99%

Clinical Characteristics of Biopsy-Proven IgA Vasculitis in Children and Adults: A Retrospective Cohort Study

Villatoro-Villar

Crowson

Warrington

et al. 2019

Mayo Clinic Proceedings

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“… Other classifications Name of classification, authors, ref. Europe Koskela et al 2017 [ 30 ] Soylemezoglu et al 2009 [ 21 ] Lucas Garcia et al 2009 [ 47 ] Mizerska-Wasiak et al 2018 [ 41 ] Gülhan et al 2015 [ 42 ] Calvo-Río et al 2013 [ 43 ] Modified semiquantitative classification Koskela et al 2017 [ 30 ] Local pathological scoring Mohey et al 2013 [ 48 ] Pillebout et al 2002 [ 49 ] The classification developed by Heaton Altugan et al 2009 [ 50 ] Classification according to Emancipator Rauta et al 2002 [ 51 ] Coppo et al 1997 [ 13 ] North America Tarshish et al 2004 [ 31 ] N/A The classification adapted from Andreoli and Bergstein Foster et al 2000 [ 52 ] The classification developed by Heaton Heaton et al 1977 [ 53 ] Meadow’s classification Meadow et al 1972 [ 54 ] Latin America Buscatti et al 2018 [ 55 ] Fuentes et al 2014 [ 56 ] de Almeida et al 2007 [ 57 ] N/A N/A Asia Inagaki et al 2018 [ 44 ] Fu et al 2016 [ 58 ] Lim et al 2016 [ 25 ] Inagaki et al 2018 [ 44 ] Xu et al 2018 [ 17 ] Kim et al 2014 [ 35 ] Japanese histologic classification Inagaki et al 2018 [ 44 ] Scoring system described by Andreoli and Bergstein Kanai et al 2011 [ 59 ] Australia N/A …”

Section: Main Textmentioning

confidence: 99%

Different histological classifications for Henoch-Schönlein purpura nephritis: which one should be used?

et al. 2019

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Background Nephritis is the most important chronic complication of IgA Vasculitis (IgAV)/Henoch-Schönlein purpura (IGAV/HSP) and thus the main prognostic factor of this most common childhood vasculitis. Since the prognosis and treatment selection depends on the mode of interpretation of biopsy material, in this manuscript we have presented several issues related to the uneven application of different histological classifications in IgAV/Henoch-Schönlein purpura nephritis (HSPN). The nephritis of IgAV/IGAV/HSP will be abbreviated as HSPN for this paper. Main body In clinical practice we use different histological classifications for HSPN. It is not known which of these classifications best correlates with severity of renal disease and renal outcome in IgAV/IGAV/HSP. One of the major problem with existing histological classifications is that there is no consensus on the implementation of biopsy in the treatment of HSPN. There is a histologic classification system conventionally used in HSPN, of the International Study of Kidney Disease in Children (ISKDC). On the other hand there is the new classification system suggested for IgA nephropathy, the Oxford classification. The latter has been validated only in IgA nephropathy. There are also two further histologic classifications of Haas and Koskela that have been developed. Current treatment strategies in HSPN are not standardised nor predominantly based on histological classification. Conclusion One of the possible solutions to problems related to the application of different histological classification in HSPN is the implementation of multicenter multinational prospective studies with joint collaboration between pediatric rheumatologists, nephrologists and nephropathologists to correlate the clinical features and outcome with the classification systems as well among the classifications. This classification should be the basis for the construction of guidelines for the treatment of patients with HSPN.

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“…The IgA vasculitis severity, particularly renal and gastrointestinal involvements, was similar between male and female patients [1,22,26]. A study from Turkey showed that renal involvement was higher in IgA vasculitis patients with scrotal involvement compared to those without this condition [22], suggesting a more severe and multisystemic disease in male patients.…”

Section: Discussionmentioning

confidence: 98%

Characterization of scrotal involvement in children and adolescents with IgA vasculitis

et al. 2018

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Objective: To characterize scrotal involvement in children and adolescents with IgA vasculitis. Methods: A cross-sectional retrospective study included 296 IgA vasculitis (EULAR/PRINTO/PRES criteria) patients, 150/296 (51%) were males and assessed by demographic/clinical/laboratory and treatments. Scrotal involvement was defined by the presence of scrotal edema and/or pain/tenderness in physical examination and/or testicular Doppler ultrasound abnormalities. Results: Scrotal involvement was observed in 28/150 (19%) IgA vasculitis patients. This complication was evidenced at IgA vasculitis diagnosis in 27/28 (96%). Acute recurrent scrotal involvement was observed in 2/150 (1%) and none had chronic subtype. Further analysis of patients with scrotal involvement at first episode (n = 27) compared to those without this complication (n = 122) revealed that the median age at diagnosis [4.0 (2.0-12) vs. 6 (1.3-13) years, p = 0.249] was similar in both groups. The frequency of elevated serum IgA was significantly lower in IgA vasculitis patients with scrotal involvement versus without this manifestation (18% vs. 57%, p = 0.017), whereas glucocorticoid (93% vs. 49%, p < 0.0001) and ranitidine use (63% vs. 30%, p = 0.003) were significantly higher in the former group. Conclusions: The scrotal involvement occurred in almost one fifth of IgA vasculitis patients and was commonly evidenced as acute subtype at diagnosis. Scrotal signs/symptoms improved after a prompt use of glucocorticoid and was associated with low frequency of elevated IgA serum levels.

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Henoch-Schönlein purpura nephritis: initial risk factors and outcomes in a Latin American tertiary center

Cited by 46 publications

References 35 publications

Clinical Characteristics of Biopsy-Proven IgA Vasculitis in Children and Adults: A Retrospective Cohort Study

Clinical Characteristics of Biopsy-Proven IgA Vasculitis in Children and Adults: A Retrospective Cohort Study

Different histological classifications for Henoch-Schönlein purpura nephritis: which one should be used?

Characterization of scrotal involvement in children and adolescents with IgA vasculitis

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