Henoch-Schnlein nephritis in adults：outcome and prognostic factors.

doi:10.7504/nk2014050503

Abstract

Abstract:

Abstract：Objective To evaluate the clinical outcomes and risk factors in adult patients with Henoch-Schnlein nephritis (HSPN).Methods A total of 76 adult patients with HSPN were enrolled in this study.They were followed up for 22 to 119 months，and the data of their clinical manifestations，renal pathological findings and outcomes were collected.Renal pathological changes were semi-quantitatively graded.Results Ten patients (13.2%) progressed to end-stage renal failure (ESRD).On univariate analysis，factors predicting ESRD were hypertension and renal impairment at presentation，proteinuria ≥1.0 g/d during following-up，and the tubulointerstitial chronicity；after the adjustment，multivariate analysis indicated the following parameters as independent prognostic predictors：renal impairment at presentation(OR=10.96，95%CI 1.56-77.26，P<0.05)and the tubulointerstitial chronicity index(OR=2.77，95%CI 1.20-6.39，P<0.05).No data detected at presentation，including age，sex，macroscopic hematuria，proteinuria ≥1.0 g/d，glomerular activity index and chronicity index were significantly related to ESRD.Conclusion Renal impairment at presentation and the tubulointerstitial chronicity index are risk factors for ESRD.

Key words: purpura, Henoch-Schonlein nephritis, adults

摘要：

目的探讨成人过敏性紫癜肾炎(Henoch-Schnlein nephritis，HSPN)预后及其危险因素。方法对福建医科大学附属第二医院2002年1月至2011年10月经肾活检证实的76例过敏性紫癜肾炎预后及其危险因素进行回顾性分析。结果平均随访57个月，10例(13.2%)进入终末期肾脏疾病(end-stage renal failure，ESRD)。单因素分析显示，起病时伴高血压、肾功能损害、随访时24 h尿蛋白定量≥1 g和肾小管间质慢性化指数是肾脏预后不良的危险因素，肾脏预后不良与性别、年龄、肾外表现、起病时肉眼血尿、就诊时24 h尿蛋白定量≥1.0 g、肾小球活动及慢性化指数和免疫抑制剂治疗无关。多因素分析显示，肾脏预后不良危险因素包括起病时肾功能损害(OR=10.96，95%CI 1.56~77.26，P<0.05)和肾小管间质慢性化指数(OR=2.77，95%CI 1.20~6.39，P<0.05)。结论成人HSPN预后较差，预后不良危险因素包括起病时肾功能损害及肾小管间质慢性化指数。

关键词: 紫癜, 肾炎, 成人

CLC Number:

R692.3

LI Yue-ting，CHEN Jin-hai，HUANG Rong-gui. Henoch-Schnlein nephritis in adults：outcome and prognostic factors.[J]. Acta Metallurgica Sinica, DOI: 10.7504/nk2014050503.

李月婷，陈锦海，黄荣桂. 成人过敏性紫癜肾炎预后及其危险因素分析[J]. 中国实用内科杂志, DOI: 10.7504/nk2014050503.

References

［1］Watts RA，Jollfiffe VA，Grattan CEH.Cutaneous vasculitis in a defined population-clinical and epidemiological associations［J］.J Rheumatol，1998，25(5)：920-924.

［2］Gardner-Medwin JM，Dolezalova P，Cummins C，et al.Incidence of Henoch-Schnlein purpura，kawasaki disease，and rare vasculitides in children of different ethnic origins［J］.Lancet，2002，360(9341)：1197-1202.

［3］Katafuchi R，Kiyoshi Y，Oh Y，et al.Glomerular score as a prognosticator in IgA nephropathy： its usefulness and limitation［J］.Clin Nephrol，1998，49(1)：1-8.

［4］王旭，栾江成，杨杏鲜，等.儿童紫癜性肾炎的临床病理及预后［J］.临床儿科杂志，2008，26(4)：309-311.

［5］冯仕品，罗苇，张伟，等.儿童紫癜性肾炎200例临床与病理分析［J］.临床儿科杂志，2011，29(7)：652-655.

［6］Coppo R，Andrulli S，Amore A，et al.Predictors of outcome in Henoch-Schnlein nephritis in children and adults［J］.Am J Kidney Dis，2006，47(6)：993-1003.

［7］Rauta V，Trnroth T，Grnhagen-Riska c G.Henoch-Schnlein nephritis in adults-clinical features and outcomes in finnish patients［J］.Clin Nephrol，2002，58(1)：1-8.

［8］García-Porrúa C，Calvio MC，Llorca J，et al.Henoch-Schnlein purpura in children and adults： clinical differences in a defined population［J］.Semin Arthritis Rheum，2002，32(3)：149-156.

［9］Shrestha S，Sumingan N，Tan J，et al.Henoch schnlein purpura with nephritis in adults： adverse prognostic indicators in a UK population［J］.Q J Med，2006，99(4)：253-265.

［10］Pillebout E，Thervet E，Hill G，et al.Henoch-Schnlein purpura in adults： outcome and prognostic factors［J］.J Am Soc Nephrol，2002，13(5)：1271-1278.

［11］Goldstein AR，White RH，Akuse R，et al.Long-term follow-up of childhood Henoch-Schnlein nephritis［J］.Lancet，1992，339(8788)：280-282.

［12］Wal Jauhola O，Ronkainen J，Koskimies O，et al.Outcome of Henoch-Schnlein purpura 8 years after treatment with a placebo or prednisone at disease onset［J］.Pediatr Nephrol，2012，27(6)：933-939.

［13］Kawasaki R，Suzuki J，Suzuki H.Efficacy of methylprednisolone and urokinase pulse therapy combined with or without cyclophosphamide in severe Henoch-Schnlein nephritis ：a clinical and histopathological study.Nephrol Dial Transplant，2004，19(4)：858-864.

［14］Ren P，Han F，Chen L，et al.The combination of mycophenolate mofetil with corticosteroids induces remission of Henoch-Schnlein purpura nephritis［J］.Am J Nephrol，2012，36(3)：271-277.

［15］Kalliakmani P，Benou E，Goumenos DS.Cyclosporin A in adult patients with Henoch-Schnlein purpura nephritis and nephrotic syndrome；5 case reports.Clin Nephrol，2011，75(4)：380-383.

2013-11-12收稿 2014-02-20修回本文编辑：颜廷梅

[1]	. [J]. Acta Metallurgica Sinica, 2014, 34(8): 826-827.
[2]	. [J]. Acta Metallurgica Sinica, 2014, 34(6): 612-613.
[3]	YANG Ren-chi.. Use of glucocorticoids in the treatment of hematological disorders. [J]. Acta Metallurgica Sinica, 2013, 33(10): 779-781.