Value of Oxford classification and ISKDC classification in the prognosis of children with Henoch-Schönlein purpura nephritis

Xueqian LI; Xiaorong Liu; Xingfeng Yao; Nan Zhang; Jianfeng Fan; Zhi Chen; Qiang Sun; Nan Zhou; Qun Meng; Chen Ling; Yeping Jiang; Lei Lei; Mengmeng Tang; Hejia Zhang; Yetong LI

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Value of Oxford classification and ISKDC classification in the prognosis of children with Henoch-Schönlein purpura nephritis

VernacularTitle: 牛津分类与国际小儿肾脏病研究组分级在评价儿童紫癜性肾炎预后中的应用
Author: Xueqian LI ^{1
,

2
,

3} ; Xiaorong LIU ^{1
,

2
,

3} ; Xingfeng YAO ^{1
,

4} ; Nan ZHANG ^{1
,

4} ; Jianfeng FAN ^{1
,

2
,

3} ; Zhi CHEN ^{1
,

2
,

3} ; Qiang SUN ^{1
,

2
,

3} ; Nan ZHOU ^{1
,

2
,

3} ; Qun MENG ^{1
,

2
,

3} ; Chen LING ^{1
,

2
,

3} ; Yeping JIANG ^{1
,

2
,

3} ; Lei LEI ^{1
,

2
,

3} ; Mengmeng TANG ^{1
,

2
,

3} ; Hejia ZHANG ^{1
,

2
,

3} ; Yetong LI ^{1
,

2
,

3}
Author Information

1. National Center for Children's Health
2. Department of Nephrology, Beijing Children's Hospital, Capital Medical University
3. Beijing Key Laboratory of Pediatric Chronic Kidney Disease and Blood Purification, Beijing Children's Hemodialysis Center, Beijing 100045, China
4. Department of Pathology, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
Publication Type:Clinical Trail
Keywords: Purpura, Henoch-Schönlein; Glomerulonephritis; Biopsy; Oxford classification; ISKDC classification; Prognosis
From: Chinese Journal of Nephrology 2020;36(1):26-33
CountryChina
Language:Chinese
Abstract: Objective:To analyze the Oxford classification (MESTC) and the International Study of Kidney Disease in Children (ISKDC) classification for evaluating the clinical manifestations, histological lesion and short-term prognosis of children with Henoch-Schönlein purpura nephritis (HSPN).
Methods:According to the Oxford classification and ISKDC classification, the histological lesions of children with HSPN diagnosed by renal biopsy from Beijing Children's Hospital affiliated to Capital Medical University from January 2018 to December 2018 were re-evaluated. The renal biopsy specimens of the selected subjects were scored according to the Oxford classification and the ISKDC classification. According to whether the first symptom was combined with renal performance, MESTC score and ISKDC classification, children were grouped. The differences in clinicopathological manifestations between the groups were compared. Correlation between MESTC and ISKDC grades was analyzed by nonparametric test rank correlation. Kaplan-Meier survival curve and Log-rank test were used to compare the difference of proteinuria remission rate between the two groups. Univariate and multivariate Cox regression equations were used to analyze the influencing factors of the proteinuria remission rate.
Results:A total of 78 children with HSPN were enrolled. There were 37 male patients (47.4%) with age of (10.4±2.9) years. When the patients were divided according to MESTC scores and ISKDC classification, the results showed that the proportion of children with nephrotic-range proteinuria in the group of endocapillary hypercellularity (E1, P=0.008), segmental glomerulosclerosis (S1, P=0.015) and ISKDCⅢ(P=0.041) was higher than that of E0, S0 and ISKDCⅡ groups. The proportion of children with E1 (P=0.015), crescents (C1&C2, P=0.025) or ISKDCⅢ(P=0.017) that had been treated with high-dose methylprednisolone was higher. The result of Kaplan-Meier survival curve showed more difficult for proteinuria remission in children with C2 are than C0&C1 group (P=0.026), while no difference were found when children were grouped by M, E, S, T and ISKDC. Multivariate Cox regression analysis showed that the C2 (HR=0.143, 95%CI 0.020-1.046, P=0.055) might be a risk factor for proteinuria remission, while the P value was close to 0.05.
Conclusions:Children with HSPN scored as ISKDCⅢ, E1 and S1 are more likely to show nephrotic-range proteinuria. C2 may indicate that patients are more difficult to achieve proteinuria remission.