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Gastrointestinal involvement and its association with the risk for nephritis in IgA vasculitis
Mario Sestan1, Nastasia Kifer1, Marijan Frkovic1
1Department of Paediatrics, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.
Insights
Severe gastrointestinal (GI) manifestations in childhood IgA vasculitis (IgAV) are predicted by specific clinical factors and lower IgM levels. Older children with early GI symptoms face a higher risk of IgAV nephritis (IgAVN).
Area of Science:
- Pediatric Rheumatology
- Gastroenterology
- Nephrology
Background:
- Childhood IgA vasculitis (IgAV) can present with severe gastrointestinal (GI) manifestations and renal complications.
- Predicting these severe outcomes is crucial for timely intervention.
Purpose of the Study:
- To identify clinical and biochemical predictors of severe GI manifestations in IgAV.
- To assess risk factors for developing IgAV nephritis (IgAVN).
Main Methods:
- A national multicentric retrospective study involving 611 children with IgAV (2009-2019).
- Logistic regression analysis was used to identify risk factors for severe GI manifestations and IgAVN.
Main Results:
- 45.99% of children experienced GI manifestations, with 14.95% having severe forms.
- Clinical predictors of severe GI manifestations included generalized rash, rash on extremities/face, and nephritis. Lower prothrombin time, fibrinogen, and IgM levels were also significant.
- Older children with initial GI symptoms and severe GI involvement had a significantly higher risk of developing IgAVN.
Conclusions:
- Specific clinical and biochemical parameters can predict severe GI manifestations in IgAV.
- Identifying high-risk children, particularly older ones with early GI symptoms, is key to preventing IgAVN and other complications.
Background:
We analysed clinical and biochemical parameters in predicting severe gastrointestinal (GI) manifestations in childhood IgA vasculitis (IgAV) and the risk of developing renal complications.
Methods:
A national multicentric retrospective study included children with IgAV reviewed in five Croatian University Centres for paediatric rheumatology in the period 2009-2019.
Results:
Out of 611 children, 281 (45.99%) had at least one GI manifestation, while 42 of 281 (14.95%) had the most severe GI manifestations. Using logistic regression several clinical risk factors for the severe GI manifestations were identified: generalized rash [odds ratio (OR) 2.09 (95% confidence interval (CI) 1.09-4.01)], rash extended on upper extremities (OR 2.77 (95% CI 1.43-5.34)] or face [OR 3.69 (95% CI 1.42-9.43)] and nephritis (IgAVN) [OR 4.35 (95% CI 2.23-8.50)], as well as lower values of prothrombin time (OR 0.05 (95% CI 0.01-0.62)], fibrinogen [OR 0.45 (95% CI 0.29-0.70)] and IgM [OR 0.10 (95% I 0.03-0.35)]] among the laboratory parameters. Patients with severe GI involvement more frequently had relapse of the disease [OR 2.14 (CI 1.04-4.39)] and recurrent rash [OR 2.61 (CI 1.27-5.38)]. Multivariate logistic regression found that the combination of age, GI symptoms at the beginning of IgAV and severity of GI symptoms were statistically significant predictors of IgAVN. Patients in whom IgAV has started with GI symptoms [OR 6.60 (95% CI 1.67-26.06)], older children [OR 1.22 (95% CI 1.02-1.46)] with severe GI form of IgAV (OR 5.90 (95% CI 1.12-31.15)] were particularly high-risk for developing IgAVN.
Conclusion:
We detected a group of older children with the onset of GI symptoms before other IgAV symptoms and severe GI form of the IgAV, with significantly higher risk for acute and chronic complications of IgAV.
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