ESPN 50th Annual Meeting

ESPN 2017


 
Prognostic value of serial kidney biopsies in Henoch-Schönlein nephritis patients - comparison of two classifications
MIKAEL KOSKELA 1 ELISA YLINEN 1 ELLI-MAIJA UKONMAANAHO 2 HELENA AUTIO-HARMAINEN 3 PäIVI HEIKKILä 4 JOUKO LOHI 4 OUTI JAUHOLA 5 JAANA RONKAINEN 6 TIMO JAHNUKAINEN 1 MATTI NUUTINEN 7

1- DEPARTMENT OF PEDIATRIC NEPHROLOGY AND TRANSPLANTATION, CHILDREN’S HOSPITAL, HELSINKI UNIVERSITY HOSPITAL AND UNIVERSITY OF HELSINKI, HELSINKI, FINLAND
2- DEPARTMENT OF CHILDREN AND ADOLESCENTS, OULU UNIVERSITY HOSPITAL, OULU, FINLAND
3- MEDICAL RESEARCH CENTER OULU AND DEPARTMENT OF PATHOLOGY, OULU UNIVERSITY HOSPITAL, OULU, FINLAND
4- DEPARTMENT OF PATHOLOGY, HELSINKI UNIVERSITY HOSPITAL, HELSINKI, FINLAND
5- DEPARTMENT OF PEDIATRICS, HYVINKää HOSPITAL, HYVINKää, FINLAND
6- OULU CITY HEALTH CARE CENTRE, OULU, FINLAND
7- PEDEGO RESEARCH UNIT AND MEDICAL RESEARCH CENTER (MRC) OULU, UNIVERSITY OF OULU AND OULU UNIVERSITY HOSPITAL, OULU, FINLAND
 
Introduction:

Prediction of clinical outcome in Henoch-Schönlein nephritis (HSN) patients is difficult. Histological findings of sequential kidney biopsies from HSN patients were classified using the ISKDC (International Study of Kidney Disease in Children) classification and a novel semiquantitative classification (SQC) and their prognostic value on patient outcomes were compared.

Material and methods:

Sequential kidney biopsies from 26 HSN patients were re-evaluated using the ISKDC classification and the SQC. SQC scores renal findings (glomerular, tubular, interstitial and vascular) and gives a total biopsy score as well as activity and chronicity indices.  The biopsy findings based on the two classification systems were compared to the clinical findings at the last control visit. Nineteen (73 %) patients had no signs of renal disease or minor urinary abnormalities (good outcome) and seven (27 %) had active renal disease or chronic kidney disease (poor outcome). Median follow-up time was 8.5 years and time elapsed between the biopsies was 2.1 years.

Results:

The patients with poor outcome had significantly higher activity and chronicity indices than patients with good outcome in both the primary kidney biopsy as well as the follow-up biopsy. Activity index increased in three cases between the two biopsies and stayed the same or decreased in 23. The respective figures for chronicity index were 22 and 4. ISKDC grading worsened in 4 and improved or stayed stable in 22. Changes between biopsies in the activity index, chronicity index and ISKDC grading occurred similarly in both outcome groups (Figure).

Conclusions:

The present findings support our previous findings suggesting that SQC is superior to ISKDC classification in predicting renal outcome in HSN patients. Activity scores decreased and chronicity scores increased between primary and follow-up biopsy despite patient outcome. The control biopsy does not seem to be indicated routinely, but needs to be decided individually.