A retrospective analysis of children with Henoch–Schonlein purpura and re-evaluation of renal pathologies using Oxford classification

Çakıcı, Evrim Kargın; Yazılıtaş, Fatma; Eroğlu, Fehime Kara; Güngör, Tülin; Arda, Nilüfer; Orhan, Dıclehan; Ateş, Funda Seher Özalp; Bülbül, Mehmet

doi:10.1007/s10157-019-01726-5

Cited by 39 publications

(31 citation statements)

References 34 publications

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“…Renal pathology findings may determine the renal outcomes of HSPN [7,8]. However, pathological classification of HSPN has been inconsistent between studies [11], and many of the previous pathological classifications provided no information on tubular atrophy and interstitial fibrosis, which has frequently been shown to predict renal outcomes [17,19,22,23]. The updated Oxford classification of IgA nephropathy includes information on various pathological features, which are graded as the MEST-C score; however, applying this classification to HSPN cases requires further validation [14].…”

Section: Discussionmentioning

confidence: 99%

“…A study of 104 children showed that S1 lesions were predictors of renal outcome, and T1/T2 were risk factors for nonremission from proteinuria [18]. A recent study involving 75 children with HSPN found that T1/T2 was an independent predictor of renal outcome, whereas the effect of S1 was dependent on the other variables [17]. Collectively, the E, S, and T scores have been shown to predict renal outcomes in HSPN.…”

Section: Discussionmentioning

confidence: 99%

“…Pooled analysis of the predictability of MEST and MEST-C scores for HSPN patients was performed using four previous studies [16][17][18][19], although the relationship for C score in adults could not be determined because the C score was defined differently in one study [19]. Two hundred ninety-two children and 235 adults were included in the meta-analysis, and their information is summarized in Table 4.…”

Section: Pooled Analysis With Previous Studiesmentioning

confidence: 99%

“…Because HSPN and IgA nephropathy share their renal pathology, a few studies have used the Oxford classification score to predict renal outcomes in HSPN [16][17][18][19]. However, these studies yielded inconsistent results for MEST-C score predictability; thus, further study is warranted.…”

Section: Introductionmentioning

confidence: 99%

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MEST-C pathological score and long-term outcomes of child and adult patients with Henoch-Schönlein purpura nephritis

Yun

Joo

et al. 2020

BMC Nephrol

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Background: Henoch-Schönlein purpura nephritis (HSPN), a small-vessel vasculitis, shares renal pathological features with immunoglobulin A nephropathy. Oxford classification of immunoglobulin A nephropathy pathology has been updated to the MEST-C score, but its application in HSPN remains unresolved. Methods: Two hundred and thirteen patients with biopsy-proven HSPN were retrieved from the Seoul National University Hospital between 2000 and 2017. Renal outcome risks (i.e., end-stage renal disease or doubling of serum creatinine) were evaluated according to MEST-C scores after stratification by age: 113 children aged < 18 years (9.2 ± 3.6 years) and 100 adults aged ≥18 years (38.6 ± 18.3 years). We pooled our data with four previous cohort studies in which MEST or MEST-C scores were described in detail.Results: Twenty-one child (19%) and 16 adult (16%) patients reached the renal outcome during the median followup periods of 12 years and 13 years, respectively (maximum 19 years). In children, M1 and T1/T2 scores revealed worse renal outcomes than did M0 and T0 scores, respectively, whereas the T score was the only factor related to worse outcomes in adult patients after adjusting for multiple clinical and laboratory variables. The pooled data showed that M1, S1, and T1/T2 in children and E1 and T1/T2 in adults were correlated with poorer renal outcomes than those of their counterpart scores. Conclusions: The Oxford classification MEST-C scores can predict long-term renal outcomes in patients with HSPN.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Pooled Analysis With Previous Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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MEST-C pathological score and long-term outcomes of child and adult patients with Henoch-Schönlein purpura nephritis

Yun

Joo

et al. 2020

BMC Nephrol

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“…Navedena međuovisnost uočena je i u prethodnim istraživanjima gdje se kao razgranična dob između skupina nižeg i višeg rizika navode 4, 6 i 8 godina života. 11,12,13 HSPN glavni je uzrok morbiditeta i mortaliteta u djece s HSP-om, a time i najvažniji čimbenik u prognozi ovih bolesnika. 14,15,16 S obzirom na to da je biopsija bubrega obvezatna za potvrdu dijagnoze nefritisa, a u konačnoj predikciji ishoda bolesnika s HSPN-om važnu ulogu ima i patohistološka klasifikacija koja se rabi pri interpretaciji nalaza biopsije, potrebno je donijeti konsenzus oko toga kada učiniti biopsiju bubrega i na koji način analizirati dobiveni materijal.…”

Section: Raspravaunclassified

Henoch-Schönlein Purpura Nephritis in Children: Experi-Ence of the Two Tertiary Care Centers for Pediatric and Adolescent Rheumatology of the Republic of Croatia From 2006 to 2017

2018

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Aim: To determine types of renal complications, indications for biopsy, treatment methods and possible outcomes in patients with Henoch-Schönlein purpura nephritis. Patients and methods: Retrospective analysis of medical data of HSP patients treated at the Department of Paediatrics, University Hospital Centre Zagreb, and the Department of Paediatrics, University Hospital Centre Split, during the period from 2006 to 2017, who developed kidney disease according to EULAR/PRINTO/PRES criteria. Results: Out of 378 patients diagnosed with HSP, 81 (21.4%) developed kidney disease, out of whom 43 boys (53.1%) and 38 girls (46.9%), with the median age 8.4 years (2.5–16.8).. A statistically significant increase of patients with HSP was during autumn and winter. There is a greater chance of nephritis with the increase of patients age at diagnosis. For every year (from 1 to 17 years) the chances increase by around 2.25%. Equal number of patients, 44.45%, had both hematuria and proteinuria or isolated hematuria, and only 11.1% isolated proteinuria. Renal biopsy was performed in 37 patients (45.7%), and most biopted patients were from concurrent hematuria and proteinuria group (70.3%). Children with isolated hematuria or with isolated proteinuria were most often treated with corticosteroids while children with hematuria and proteinuria were most often treated with corticosteroids and angiotensin-converting enzyme inhibitors. Immunosuppressives were used in 16% of the patients, including most of those in the group with concurrent hematuria and proteinuria (69.2%). Only one patient (1.2%) developed renal insufficiency with the need for dialysis, while the outcome of the others was evaluated as good. Conclusion: Renal complications are the most important factor in the outcome of patients with HSP. For the optimal treatment of these patients it is necessary to bring consensus about the indications for kidney biopsy in HSP, and also to validate the existing pathohistological classification to affirm which one best correlates with the adverse outcome of the disease.

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Henoch Schönlein Purpura Nephropathy

Nakanishi

Peruzzi

Fogo

et al. 2022

Pediatric Nephrology

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A retrospective analysis of children with Henoch–Schonlein purpura and re-evaluation of renal pathologies using Oxford classification

Cited by 39 publications

References 34 publications

MEST-C pathological score and long-term outcomes of child and adult patients with Henoch-Schönlein purpura nephritis

MEST-C pathological score and long-term outcomes of child and adult patients with Henoch-Schönlein purpura nephritis

Henoch-Schönlein Purpura Nephritis in Children: Experi-Ence of the Two Tertiary Care Centers for Pediatric and Adolescent Rheumatology of the Republic of Croatia From 2006 to 2017

Henoch Schönlein Purpura Nephropathy

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