Kidney Disease in Children

Pathologic features of HSPN is usually by the International Study of Kidney Disease in Children (ISKDC) classification; mainly according to the existence and the number of crescents. However, the value of crescents in predicting long-term outcome of HSPN is still lack of consensus. IgA nephropathy shares many similarities with HSPN in clinical; immunological and histological features.
In some studies, IgA nephropathy and HSPN  regarded as different manifestations of a single disease. Therefore, the Oxford classification of IgA nephropathy may also used to group pathologic features of HSPN. The updated Oxford classification uses mesangial hypercellularity (M), endocapillary hypercellularity (E), segmental sclerosis (S), tubular atrophy/ interstitial fibrosis (T) and crescents (C) to evaluate renal biopsies.

Outcomes of HSPN in children

A study published in 2014 suggested that the original Oxford classification was of prognostic value in HSPN; while another study in 2018 suggesting that updated oxford classification can used to assess renal outcomes of HSPN in children. Here, the researcher evaluated the utility of both the ISKDC classification and the updated Oxford classification as a predictor of the renal outcome by retrospectively reviewing a larger cohort (275 patients, aged≥14 years)followed up in our center.

Therefore the \data of 292 HSPN patients diagnosing by the Kidney Disease Center of the First Affiliated Hospital of Zhejiang University between August 2004 and November 2015 retrieved. So criteria for a renal biopsy was HSPN patients who had active urinary sediments with or without impairment of glomerular filtration rate. But inclusive criteria included: aged ≥14 years; a history of palpable purpuric eruption, with or without the involvement of gastrointestinal tract or joints; biopsy-proven HSPN.

Exclusion criteria were as follows: inadequate number of glomeruli (< 8) in the biopsy; concomitant with cirrhotic liver disease, IgA-dominant infection-glomerulonephritis; human immunodeficiency virus-IgA nephropathy, anti-neutrophil cytoplasmic antibody-associated vasculitis, hepatitis B virus-associated nephritis, idiopathic thrombocytopenic purpura, systemic lupus erythematosus, and other autoimmune diseases.

Anti-neutrophil cytoplasmic antibody

Levels of the antinuclear antibody (ANA), anti-neutrophil cytoplasmic antibody (ANCA), anti-glomerular basement antibody together with compliments was collecting to exclude autoimmune disease. During the follow-up period of 56(30,86) months, 30(10.9%) patients reached renal endpoints. Segmental sclerosis was the only pathological feature independently with renal endpoints (HR 4.086, 95%CI 1.111-15.026, P = 0.034).
Tubular atrophy/ interstitial fibrosis was associated with eGFR and Scr levels; its correlation with renal endpoints was found by univariate analysis. Endocapillary hypercellularity was with 24 h urine protein and is of prognostic value in univariate analysis. Mesangial hypercellularity was not associated with clinical features or renal endpoints.
Crescents with 24 h urine protein, Scr and eGFR levels, but both ISKDC and updated Oxford classifications of crescents not associated with renal endpoints by multivariate analysis. The updated Oxford classification can help in disease management and renal outcome prediction of HSPN.