ESPN 50th Annual Meeting

ESPN 2017


 
Clinical outcomes in children with Henoch–Schönlein purpura nephritis without crescents
JEAN-DANIEL DELBET 1 JULIEN HOGAN 2 BILAL AOUN 1 IULIA STOICA 1 REMI SALOMON 3 STEPHANE DECRAMER 4 ISABELLE BROCHERIOU 5 GEORGES DESCHENES 2 TIM ULINSKI 1

1- PEDIATRIC NEPHROLOGY, ARMAND TROUSSEAU HOSPITAL, APHP, AND UNIVERSITY PIERRE AND MARIE CURIE, PARIS, FRANCE
2- PEDIATRIC NEPHROLOGY, ROBERT DEBRé HOSPITAL, APHP, PARIS, FRANCE
3- PEDIATRIC NEPHROLOGY, NECKER ENFANTS MALADES, APHP, PARIS, FRANCE
4- PEDIATRIC NEPHROLOGY AND RHUMATOLOGY, CHU TOULOUSE, PARIS, FRANCE
5- PATHOLOGY DEPARTMENT, TENON HOSPITAL, APHP, PARIS, FRANCE
 
Introduction:

Henoch-Schonlein purpura is the most common vasculitis in children. Its long-term prognosis depends on renal involvement. The management of Henoch-Schonlein purpura nephritis (HSPN) remains controversial. This study reports the prognosis of children with HSPN presenting with class 2 ISKDC nephritis.

Material and methods:

All children with HSPN Class 2 diagnosed between 1995 and 2015 in four pediatric nephrology centers were included and clinical and biological data were collected from the medical files. The primary endpoint was the remission of proteinuria defined as a proteinuria <200mg/L.

Results:

92 children were included with a median follow-up time of 36 months. 28% had nephrotic syndrome, 31% proteinuria> 3 g/L, 52% proteinuria between 1 and 3 g/L and 18% proteinuria <1 g/L. 47% received treatment with oral steroids alone, 37% received methylprednisolone pulses followed by oral steroids, 18% have not been treated with steroids. 85% reached remission during follow-up but 12% of them did not maintain complete remission over time so that only 75% remained in complete remission by the end of the follow-up. Univariate analysis found a linear increase of the likelihood of remission with initial proteinuria (p = 0.009). This trend was not found in the multivariate analysis after adjusting for treatments as patients with higher proteinuria were most often treated with steroids.

Conclusions:

Our study underlines that one fourth of the patients with HSPN class 2 remains proteinuric and thus carry the risk of developing chronic kidney disease on the long term. This finding together with the better outcome of patients who have received steroids is in favor of treating those patients.