Clinicopathologic correlations in Henoch-Schonlein nephritis

Renal involvement is the major cause of mortality and morbidity in children with Henoch-Schonlein purpura. The purpose of this study was to determine the predictive factors of Henoch-Schonlein nephritis (HSN) and correlations between clinical and pathologic findings.

Demographic characteristics and clinical manifestations of 105 children with Henoch-Schonlein purpura were retrospectively evaluated. Kidney biopsy with pathologic scoring was performed in 17 patients.

Sixty-one boys and 44 girls were included in this study. The mean age at presentation was 73.0 ± 33.4 months (range, 12 to 156 months). Thirty-nine percent of patients had renal involvement. Their mean age at presentation of HSN was 87.4 ± 30.9 months, which was significantly higher than the age of those without nephritis. Age at presentation was the only predictor of renal involvement. Hematuria and proteinuria were the most common laboratory findings of HSN, followed by nephrotic syndrome and acute nephritis. The most common histologic findings were grades 3 (especially 3B) and 2 of the International Study of Kidney Disease in Children classification, respectively. Higher pathologic grades were more frequent in patients with nephrotic syndrome and acute nephritis. Similarly, there was a positive relationship between the severity of proteinuria and both pathologic grading and scoring, especially crescent formation, endocapillary proliferation, and tubular atrophy.

There was a significant correlation between the severity of renal involvement and pathologic grading and scoring in HSN. The severity of proteinuria was a significant determinant of renal pathologic findings.