Predictors of outcome in Henoch–Schönlein nephritis.

SCHOENLEIN-Henoch purpura; GLOMERULAR filtration rate; KIDNEY diseases; TREATMENT effectiveness; PEDIATRIC nephrology; PROTEINURIA in children; RENAL biopsy; PROGNOSIS

Factors predictive of renal outcome were studied in 78 children with Henoch–Schönlein nephritis followed up for as long as 17 (mean 5.2) years. Patients with a good outcome (74%) were healthy or had microalbuminuria or mild proteinuria at the final follow-up (FU), and those with poor outcome (26%) had active renal disease or chronic kidney disease at stages IV–V. Patients with mild symptoms at onset (hematuria ± mild proteinuria) had a poor outcome in 15% of cases versus 41% of those with severe symptoms (nephritic or nephrotic syndrome or nephritic-nephrotic picture) ( p = 0.011). However, among patients with mild proteinuria at onset, 18% showed a poor prognosis; non-nephrotic proteinuria with a urine albumin/creatinine ratio at a cut-off value of >144 mg/mmol at the 1-year FU was predictive of a poor outcome. Among 59 biopsied patients, 37% of those with advanced histological findings [International Study of Kidney Disease in Children (ISKDC) stages III–V] had a poor outcome compared to none of those with mild findings (ISKDC stages I–II) ( p = 0.0015). Patients with a poor outcome were older at onset, had more proteinuria, and lower glomerular filtration rate at the 1-year FU compared with patients with a good outcome. Multivariate analysis showed that proteinuria at the 1-year FU and the ISKDC grading score of the renal biopsy were the two most discriminant factors of a poor prognosis. [ABSTRACT FROM AUTHOR]