University of Oulu

Koskela, M., Ylinen, E., Autio-Harmainen, H. et al. Prediction of renal outcome in Henoch–Schönlein nephritis based on biopsy findings. Pediatr Nephrol 35, 659–668 (2020). https://doi.org/10.1007/s00467-019-04415-3

Prediction of renal outcome in Henoch–Schönlein nephritis based on biopsy findings

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Author: Koskela, Mikael1,2; Ylinen, Elisa2; Autio-Harmainen, Helena3;
Organizations: 1Children’s Hospital, Pediatric Research Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
2Department of Pediatric Nephrology and Transplantation, New Children’s Hospital, University of Helsinki and Helsinki University Hospital, PO Box 347, Stenbäckinkatu 9, 00029, Helsinki, Finland
3Medical Research Center Oulu and Department of Pathology, Oulu University Hospital, Oulu, Finland
4Department of Pathology, Helsinki University Hospital, Helsinki, Finland
5Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
6PEDEGO Research Unit, Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Medical Research Center Oulu (MRC Oulu), Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.6 MB)
Persistent link: http://urn.fi/urn:nbn:fi-fe2020050825749
Language: English
Published: Springer Nature, 2020
Publish Date: 2020-05-08
Description:

Abstract

Background: In Henoch–Schönlein nephritis (HSN), a risk factor for unfavorable outcome is prolonged proteinuria, but the value of renal biopsies in prognosis assessment is debatable.

Methods: We evaluated serial renal biopsies from 26 HSN patients. Follow-up biopsy occurred at median 2.1 years after diagnostic biopsy. Patients formed two groups at the follow-up biopsy: patients without proteinuria (group I; n = 11) and with proteinuria (group II; n = 15). Biopsies underwent evaluation according to three classifications: International Study of Kidney Disease in Children (ISKDC), Oxford (MEST-C), and semiquantitative classification (SQC) including an activity and chronicity score. Analysis also included expression of pro-fibrotic (alpha-smooth muscle actin and vimentin) and inflammatory (P-selectin glycoprotein ligand-1) molecules in the diagnostic biopsy specimens. Definition of unfavorable outcome was active renal disease or reduced renal function at last follow-up.

Results: Between the biopsies, SQC chronicity score increased in 22 (85%) patients, whereas activity score and ISKDC grade decreased in 21 (81%) and 17 (65%), respectively. Of the MEST-C parameters, endocapillary proliferation (from 83 to 13%; p < 0.001) and crescents (from 63 to 25%; p = 0.022) showed significant reduction, and segmental glomerulosclerosis (from 38 to 79%; p = 0.006) significant increment. These changes occurred similarly in groups I and II. Expression of the pro-fibrotic and inflammatory molecules showed no clinically significant differences between groups I and II. None in group I and five (33%) patients in group II had unfavorable outcome (p = 0.053).

Conclusions:Our results suggest that follow-up biopsies provide limited additional information to clinical symptoms in HSN outcome prediction.

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Series: Pediatric nephrology
ISSN: 0931-041X
ISSN-E: 1432-198X
ISSN-L: 0931-041X
Volume: 35
Issue: 4
Pages: 659 - 668
DOI: 10.1007/s00467-019-04415-3
OADOI: https://oadoi.org/10.1007/s00467-019-04415-3
Type of Publication: A1 Journal article – refereed
Field of Science: 3111 Biomedicine
3121 General medicine, internal medicine and other clinical medicine
3123 Gynaecology and paediatrics
Subjects:
Funding: Open access funding provided by University of Helsinki including Helsinki University Central Hospital. The Finnish Kidney Foundation, the Foundation for Pediatric Research, the Orion Research Foundation, and the Alma and K.A. Snellman Foundation, Oulu, Finland supported this study by a grant to M.K.
Copyright information: © The Author(s) 2019. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
  https://creativecommons.org/licenses/by/4.0/