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Predictors of outcome in Henoch–Schönlein nephritis

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Abstract

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.

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Acknowledgements

This study was financially supported by the Frimurarna Association, the Jerring Foundation and the Swedish Medical Research Council (nr. 6864). Financial support was also provided through the regional agreement on medical training and clinical research (ALF) between Stockholm county council and the Karolinska Institutet.

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Authors and Affiliations

  1. Department of Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska Institutet, Astrid Lindgren Children´s Hospital, Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden

    Stella Edström Halling & Ulla B. Berg

  2. Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet–Karolinska University Hospital, Huddinge, 141 86, Stockholm, Sweden

    Magnus P. Söderberg

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  1. Stella Edström Halling
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  2. Magnus P. Söderberg
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  3. Ulla B. Berg
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Correspondence to Stella Edström Halling.

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Edström Halling, S., Söderberg, M.P. & Berg, U.B. Predictors of outcome in Henoch–Schönlein nephritis. Pediatr Nephrol 25, 1101–1108 (2010). https://doi.org/10.1007/s00467-010-1444-y

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  • DOI: https://doi.org/10.1007/s00467-010-1444-y

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