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

Han Chan¹, Yan-Ling Tang¹, Xiao-Hang Lv¹

¹Department of Nephrology, Key Laboratory of the Ministry of Education, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China.

|December 1, 2016

Insights

Identifying risk factors for kidney disease in Henoch-Schönlein purpura (HSP) is crucial for children. Male gender, older age, severe gastrointestinal issues, and elevated WBC/platelets are linked to renal involvement in pediatric HSP.

Area of Science:

Pediatric Nephrology
Rheumatology
Immunology

Background:

Henoch-Schönlein purpura (HSP) is a significant cause of kidney disease in children.
Early identification of risk factors for renal involvement is critical for timely intervention.

Purpose of the Study:

To conduct a meta-analysis to identify risk factors associated with renal involvement in childhood HSP.
To provide evidence for clinical interventions aimed at preventing kidney disease in pediatric HSP.

Main Methods:

Systematic literature search of PubMed, Embase, and Web of Science databases.
Quality assessment of eligible studies using the Newcastle-Ottawa scale.
Meta-analysis of risk factors, reporting odds ratios (OR) and weighted mean differences (WMD) with 95% confidence intervals.

Main Results:

Thirteen studies involving 2398 children identified 13 significant risk factors for renal involvement in HSP.
Key risk factors include older age (>10 years), male gender, severe gastrointestinal symptoms (abdominal pain, bleeding, bowel angina), persistent purpura, relapse, elevated WBC count, elevated platelet count, elevated antistreptolysin O (ASO), and decreased complement component 3 (C3).
Arthritis/arthralgia was also identified as a potential risk factor.

Conclusions:

Male gender, older age, severe gastrointestinal symptoms, arthritis/arthralgia, persistent purpura/relapse, elevated WBC, elevated platelets, elevated ASO, and low C3 are associated with renal involvement in pediatric HSP.
Clinical interventions targeting these risk factors may help prevent kidney disease in early-stage HSP.
Study findings should be interpreted with caution due to inherent limitations of the included studies.

Read full analysis

Abstract

Background And Objective:

Henoch-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.

Methods:

PubMed, 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).

Results:

Thirteen 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).

Conclusion:

The 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.

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