Risk Factors Associated with Renal Involvement in Childhood Henoch-Schönlein Purpura: A Meta-Analysis

Abstract

Background and objectiveHenoch-Schönlein purpura (HSP) is an important cause of chronic kidney disease in children. This meta-analysis identified risk factors associated with renal involvement in childhood HSP.MethodsPubMed, Embase, and Web of Science were searched. The quality of all eligible studies was assessed using the Newcastle-Ottawa scale criteria. An analysis of possible risk factors was conducted to report the odds ratio (OR) and weighted mean difference (WMD).ResultsThirteen studies (2398 children) revealed 20 possible and 13 significant risk factors associated with renal involvement in HSP, with the following meta-analysis estimates of OR and WMD, with 95% confidence intervals: older age (0.90, 0.61–1.19); age > 10 y (3.13, 1.39–7.07); male gender (1.36, 1.07–1.74); abdominal pain (1.94,1.24–3.04); gastrointestinal bleeding (1.86, 1.30–2.65); severe bowel angina (3.38, 1.17–9.80); persistent purpura (4.02, 1.22–13.25); relapse (4.70, 2.42–9.14); WBC > 15 × 109/L (2.42, 1.39–4.22); platelets > 500 × 109/L (2.98, 1.22–7.25); elevated antistreptolysin O (ASO) (2.17, 1.29–3.64); and decreased complement component 3 (C3) (3.13, 1.62–6.05). Factors not significantly associated with renal involvement were: blood pressure; orchitis; elevated C-reactive protein; elevated erythrocyte sedimentation rate (ESR); and elevated serum IgA/IgE or IgG. Arthritis/arthralgia may be a risk factor according to the criteria of the American College of Rheumatology (1.41, 1.01–1.96).ConclusionThe following are associated with renal involvement in pediatric HSP: male gender; > 10 y old; severe gastrointestinal symptoms (abdominal pain, gastrointestinal bleeding, and severe bowel angina); arthritis/arthralgia; persistent purpura or relapse; WBC > 15 × 109/L; platelets > 500 × 109/L; elevated ASO; and low C3. Relevant clinical interventions for these risk factors may exert positive effects on the prevention of kidney disease during the early stages of HSP. However, the results should be interpreted cautiously due to the limitations of the studies.

Altered B cells homeostasis in child-onset immunoglobulin A vasculitis

“…Although IgAV is benign and self-limiting, and majority of patients enter remission, the degree of renal damage determines the long-term prognosis of the IgAV patients, particularly males > 10 years of age with severe gastrointestinal symptoms (abdominal pain, gastrointestinal bleeding, and severe bowel angina), arthritis/arthralgia, persistent purpura or relapse, WBC > 15 × 10 9 /L, platelets > 500 × 10 9 /L, elevated ASO, and low C3 [28]. Henoch-Schönlein purpura nephritis (HSPN) is a major cause of mortality and morbidity in children with HSP, which occurs in 30%-80% of patients during the first three weeks of the initial presentation [29].…”

Risk factors of long hospital stay for immunoglobulin A vasculitis: Single‐center study

“…The length of hospitalization was calculated as the actual period of time from admission to discharge. Based on previous studies of the potential risk factors related to prolonged hospitalization, we collected the following information from the patients’ medical records: age, gender, previous episodes, abdominal pain, GI bleeding, GI symptoms other than abdominal pain, fever, use of glucocorticoid before or on admission day, laboratory and urinalysis data, ultrasound findings, and the length of hospital stay …”

“…Based on previous studies of the potential risk factors related to prolonged hospitalization, we collected the following information from the patients' medical records: age, gender, previous episodes, abdominal pain, GI bleeding, GI symptoms other than abdominal pain, fever, use of glucocorticoid before or on admission day, laboratory and urinalysis data, ultrasound findings, and the length of hospital stay. 4,6,7,[10][11][12][13] Gastrointestinal bleeding was defined as hematemesis, melena, hematochezia, or positive stool guaiac test. Stool guaiac test was conducted on a case-by-case basis.…”

Predisposing factors of childhood Henoch-Schönlein purpura in Anhui province, China

“…Renal damage is one of the substantial factors for HSP prognosis. Based on the data from 13 studies encompassing 2398 children with HSP, a meta-analysis by Chan et al 4 indicated that 40.6% of them had renal involvement, and moreover male gender, aged >10 years, severe gastrointestinal symptoms, arthritis/arthralgia, persistent/relapse purpura, leukocytosis, thrombocytosis, elevated antistreptolysin O (ASO), decreased complement component 3 (C3) and proteinuria were predictive of end-stage renal disease. In contrast, an epidemiological analysis of 13 519 renal biopsies from a single unit in China showed that 20.3% prevalent etiology of secondary glomerulonephritis may be derived from the juvenile HSP 5.…”