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01-02-2018 | Original Article

Presentation of pediatric Henoch–Schönlein purpura nephritis changes with age and renal histology depends on biopsy timing

Authors: Imke Hennies, Charlotte Gimpel, Jutta Gellermann, Kristina Möller, Brigitte Mayer, Katalin Dittrich, Anja K. Büscher, Matthias Hansen, Wiebke Aulbert, Elke Wühl, Richard Nissel, Gessa Schalk, Lutz T. Weber, Michael Pohl, Simone Wygoda, Rolf Beetz, Günter Klaus, Henry Fehrenbach, Sabine König, Hagen Staude, Ortraud Beringer, Martin Bald, Ulrike Walden, Christian von Schnakenburg, Gunhard Bertram, Michael Wallot, Karsten Häffner, Thorsten Wiech, Peter F. Hoyer, Martin Pohl, for the German Society of Pediatric Nephrology

Published in: Pediatric Nephrology | Issue 2/2018

Abstract

Background

This study correlates the clinical presentation of Henoch–Schönlein purpura nephritis (HSPN) with findings on initial renal biopsy.

Methods

Data from 202 pediatric patients enrolled in the HSPN registry of the German Society of Pediatric Nephrology reported by 26 centers between 2008 and 2014 were analyzed. All biopsy reports were re-evaluated for the presence of cellular crescents or chronic pathological lesions (fibrous crescents, glomerular sclerosis, tubular atrophy >5%, and interstitial fibrosis >5%).

Results

Patients with HSPN with cellular glomerular crescents were biopsied earlier after onset of nephritis (median 24 vs 36 days, p = 0.04) than those without, whereas patients with chronic lesions were biopsied later (57 vs 19 days, p < 0.001) and were older (10.3 vs 8.6 years, p = 0.01) than those without. Patients biopsied more than 30 days after the onset of HSPN had significantly more chronic lesions (52 vs 22%, p < 0.001), lower eGFR (88 vs 102 ml/min/1.73m², p = 0.01), but lower proteinuria (2.3 vs 4.5 g/g, p < 0.0001) than patients biopsied earlier. Children above 10 years of age had lower proteinuria (1.98 vs 4.58 g/g, p < 0.001), lower eGFR (86 vs 101 ml/min/1.73m², p = 0.002) and were biopsied significantly later after onset of nephritis (44 vs 22 days, p < 0.001) showing more chronic lesions (45 vs 30%, p = 0.03). Proteinuria and renal function at presentation decreased with age.

Conclusions

In summary, we find an age-dependent presentation of HSPN with a more insidious onset of non-nephrotic proteinuria, impaired renal function, longer delay to biopsy, and more chronic histopathological lesions in children above the age of 10 years. Thus, HSPN presents more like Immunoglobulin A (IgA) nephritis in older than in younger children.

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Title: Presentation of pediatric Henoch–Schönlein purpura nephritis changes with age and renal histology depends on biopsy timing
Authors: Imke Hennies
Charlotte Gimpel
Jutta Gellermann
Kristina Möller
Brigitte Mayer
Katalin Dittrich
Anja K. Büscher
Matthias Hansen
Wiebke Aulbert
Elke Wühl
Richard Nissel
Gessa Schalk
Lutz T. Weber
Michael Pohl
Simone Wygoda
Rolf Beetz
Günter Klaus
Henry Fehrenbach
Sabine König
Hagen Staude
Ortraud Beringer
Martin Bald
Ulrike Walden
Christian von Schnakenburg
Gunhard Bertram
Michael Wallot
Karsten Häffner
Thorsten Wiech
Peter F. Hoyer
Martin Pohl
for the German Society of Pediatric Nephrology
Publication date: 01-02-2018
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Nephrology / Issue 2/2018
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-017-3794-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Presentation of pediatric Henoch–Schönlein purpura nephritis changes with age and renal histology depends on biopsy timing

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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