Prediction of renal outcome in Henoch–Schönlein nephritis based on biopsy findings
Koskela, Mikael; Ylinen, Elisa; Autio-Harmainen, Helena; Tokola, Heikki; Heikkilä, Päivi; Lohi, Jouko; Jalanko, Hannu; Nuutinen, Matti; Jahnukainen, Timo (2019-12-03)
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
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https://urn.fi/URN:NBN:fi-fe2020050825749
Tiivistelmä
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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