Renal Outcomes of Childhood IgA Nephropathy and Henoch Schönlein Purpura Nephritis

Thanaporn  Chaiyapak; Anirut  Pattaragarn; Suroj  Supavekin; Nuntawan  Piyaphanee; Kraisoon  Lomjansook; Julaporn  Pooliam; Achra  Sumboonnanonda

doi:10.33192/Smj.2021.88

Authors

Thanaporn Chaiyapak Department of Pediatrics, Division of Nephrology,Faculty of Medicine Siriraj Hospital, Mahidol University
Anirut Pattaragarn Department of Pediatrics, Division of Nephrology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Suroj Supavekin Department of Pediatrics, Division of Nephrology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Nuntawan Piyaphanee Department of Pediatrics, Division of Nephrology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Kraisoon Lomjansook Department of Pediatrics, Division of Nephrology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Julaporn Pooliam Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Achra Sumboonnanonda Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok

DOI:

https://doi.org/10.33192/Smj.2021.88

Keywords:

Chronic kidney disease, Chronic renal disease, End-stage renal disease, Henoch-Schönlein purpura nephritis, IgA nephropathy

Abstract

Background: Henoch-Schönlein purpura nephritis (HSPN) is considered the systemic form of IgA nephropathy (IgAN). However, differing clinicopathological features and renal outcomes of children with IgAN and HSPN have been reported in some studies.

Methods: This study retrospectively reviewed children with IgAN and HSPN younger than 18 years, between January 2004 and December 2015. The clinicopathological characteristics at diagnosis and the renal outcomes after at least 1 year of follow-up were compared between the two groups.

Results: A total of 54 children, comprising 21 with IgAN and 33 with HSPN, were recruited. The children with HSPN were younger than the children with IgAN. Gross hematuria and nephritic syndrome at the initial presentation were more common in children with IgAN. Regarding the pathological findings, IgAN had greater chronicity than HSPN. After a median follow-up period from first presentation to renal outcomes measurement of 4.0 years (1.3-12.2) in children with IgAN and 4.2 years (1.1-11.4) in children with HSPN, the renal outcomes were better in the latter group. The incidence of chronic kidney disease (CKD) was 28.6% in children with IgAN and 6.1% in children with HSPN (p = 0.02). Complete recovery was observed more frequently in children with HSPN than in children with IgAN (57.1% in IgAN vs. 87.9% in HSPN, p = 0.01).

Conclusions: Childhood IgAN has greater chronicity and worse renal outcomes than childhood HSPN, with a lower rate of complete recovery and a higher frequency of CKD. We recommend long-term follow-up for CKD in children with IgAN.

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