Clinical features of IgA vasculitis with positive antineutrophil cytoplasmic antibody in children
10.3760/cma.j.cn112140-20250505-00385
- VernacularTitle:抗中性粒细胞胞质抗体阳性的IgA血管炎患儿临床特征分析
- Author:
Junli WAN
1
;
Pan LI
1
;
Liwen TAN
1
;
Jia JIAO
1
;
Qin YANG
1
;
Cheng ZHONG
1
;
Gaofu ZHANG
1
;
Haiping YANG
1
;
Qiu LI
1
;
Mo WANG
1
Author Information
1. 重庆医科大学附属儿童医院肾脏科 国家儿童健康与疾病临床医学研究中心 儿童发育疾病研究教育部重点实验室 儿童代谢与炎症性疾病重庆市重点实验室 重庆市卫生健康委儿童重要器官发育与疾病重点实验室，重庆 400014
- Publication Type:Journal Article
- Keywords:
Child;
IgA vasculitis;
Antineutrophil cytoplasmic antibody;
Clinical fcatures;
Prognosis
- From:
Chinese Journal of Pediatrics
2025;63(9):972-979
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the clinical features and risk factors for renal injury in children with antineutrophil cytoplasmic antibody (ANCA)-positive IgA vasculitis (IgAV).Methods:A case-control study was conducted. Seventy-two ANCA-positive IgAV children hospitalized at the Children′s Hospital of Chongqing Medical University from January 2017 to October 2022 were enrolled as the ANCA-positive group. Propensity score matching (1∶4) using the nearest neighbor was performed with age and gender as covariate, and 288 cases ANCA-negative IgAV children were included as the ANCA-negative group. Patients with renal injury were named ANCA-positive IgAV nephritis (IgAVN) group and ANCA-negative IgAVN group, respectively. The ANCA-positive IgAVN group was further divided into myeloperoxidase (MPO) group and proteinase 3 (PR3) group based on the type of ANCA. Clinical data including manifestations, laboratory tests, renal injury, and prognosis were collected. Comparisons between groups were performed using independent sample t-tests, Mann-Whitney U tests, χ2 tests, or Fisher′s exact tests. Kaplan-Meier curves were used to assess differences in the time to renal injury onset, and multivariate logistic regression was performed to identify independent risk factors for renal injury. Results:Among the 72 ANCA-positive IgAV children (41 males, 31 females, age of 7.7 (5.3, 11.2) years), no significant difference in age or gender was observed compared to the ANCA-negative group (both P>0.05). The ANCA-positive group had higher IgM levels, a higher incidence of recurrent rash, and shorter thrombin time (all P<0.05). Among children with renal injury, the ANCA-positive group showed significant differences in the incidence of hematuria, clinical classification, and grade A prognosis compared to the ANCA-negative group (all P<0.05), but no difference was found in the time to renal involvement onest or renal pathology (all P>0.05). The MPO group had higher rates of microscopic hematuria, gross hematuria, acute renal insufficiency, glomerular sclerosis, and grade B prognosis compared to the ANCA-negative IgAVN group (all P<0.05), with a later onset of renal involvement ( P<0.05). Elevated serum creatinine ( OR=1.08, 95% CI 1.03-1.14) and shortened thrombin time ( OR=0.71, 95% CI 0.55-0.92) were independent risk factors for renal injury in ANCA-positive IgAV children (all P<0.05). Conclusions:Children with ANCA-positive IgAV are more likely to experience recurrent rash. MPO-ANCA-positive IgAVN children have higher risks of hematuria, acute kidney injury and glomerular sclerosis, with later-onset but poorer renal prognosis compared to ANCA-negative IgAVN children. Higher serum creatinine levels and shorter thrombin time may be associated with renal injury in children with ANCA-positive IgAV.
