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IgA vasculitis nephritis clinical course and kidney biopsy - national study in children
The aim of the study was to investigate the relationship between the severity of typical clinical symptoms, severity of histopathological lesions in kidney biopsies in IgA vasculitis nephritis (IgAVN) and to propose indications for kidney biopsy in children. This retrospective study enrolled 106 pat...
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| Published in: | Pediatric Rheumatology 2021-10, Vol.19 (1), p.150-150, Article 150 |
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| creator | Mizerska-Wasiak, Małgorzata Turczyn, Agnieszka Cichoń-Kawa, Karolina Małdyk, Jadwiga Miklaszewska, Monika Drożdż, Dorota Bieniaś, Beata Sikora, Przemysław Drożyńska-Duklas, Magdalena Żurowska, Aleksandra Szczepańska, Maria Pańczyk-Tomaszewska, Małgorzata |
| description | The aim of the study was to investigate the relationship between the severity of typical clinical symptoms, severity of histopathological lesions in kidney biopsies in IgA vasculitis nephritis (IgAVN) and to propose indications for kidney biopsy in children.
This retrospective study enrolled 106 patients, included in the IgAVN registry of Polish children, diagnosed by kidney biopsy. Renal and extrarenal symptoms at onset of the disease were analyzed. Biopsy results were assessed using Oxford classifications (MEST-C). The patients were divided into 3 groups depending on the severity of proteinuria: A-nephrotic proteinuria with hematuria; B-non-nephrotic proteinuria with hematuria; C-isolated hematuria.
The first symptoms of nephropathy were observed at the 0.7 (1-128.4) months from the onset of extrarenal symptoms. Kidney biopsy was performed on 39 (6-782) days after the onset of nephropathy symptoms. MEST-C score 4 or 5 was significantly more frequent in children from group A than in groups B and C. Significantly higher mean MEST-C score was found in patients with abdominal symptoms than without. In group A: S0 and T0 we found in significantly shorter time to kidney biopsy than in S1, T1-2 p |
| doi_str_mv | 10.1186/s12969-021-00616-z |
| format | article |
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This retrospective study enrolled 106 patients, included in the IgAVN registry of Polish children, diagnosed by kidney biopsy. Renal and extrarenal symptoms at onset of the disease were analyzed. Biopsy results were assessed using Oxford classifications (MEST-C). The patients were divided into 3 groups depending on the severity of proteinuria: A-nephrotic proteinuria with hematuria; B-non-nephrotic proteinuria with hematuria; C-isolated hematuria.
The first symptoms of nephropathy were observed at the 0.7 (1-128.4) months from the onset of extrarenal symptoms. Kidney biopsy was performed on 39 (6-782) days after the onset of nephropathy symptoms. MEST-C score 4 or 5 was significantly more frequent in children from group A than in groups B and C. Significantly higher mean MEST-C score was found in patients with abdominal symptoms than without. In group A: S0 and T0 we found in significantly shorter time to kidney biopsy than in S1, T1-2 p < 0.05) and in group B the significantly shorter time in T0 compare to T1-2 p < 0.05). The ROC analysis shows that S1 changes appear in kidney biopsies in group A with cut off 21 days (AUC 0,702, p = 0.004, sensitivity 0.895 specificity 0.444) T1-2 changes after 35 days (AUC 0.685, p = 0.022, sensitivity 0.750, specificity 0.615), and in goupn B T1-2 cut off is 74 days (AUC 0,738, p = 0.002, sensitivity 0.667, specificity 0.833).
In childhood IgAVN, the severity of changes in the urine is clearly reflected in the result of a kidney biopsy. The biopsy should be performed in patients with nephrotic proteinuria no later than 3 weeks after the onset of this symptom in order to promptly apply appropriate treatment and prevent disease progression. Accompanying abdominal symptoms predispose to higher MESTC score.</description><identifier>ISSN: 1546-0096</identifier><identifier>EISSN: 1546-0096</identifier><identifier>DOI: 10.1186/s12969-021-00616-z</identifier><identifier>PMID: 34620183</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Abdomen ; Adolescent ; Age ; Antibodies ; Biopsy ; Biopsy - methods ; Child ; Child, Preschool ; Children ; Clinical trials ; Creatinine ; Development and progression ; Disease Progression ; Female ; Follow-Up Studies ; Hematuria ; Henoch-Schönlein purpura and other vasculitides ; Humans ; Hypertension ; IgA Vasculitis - diagnosis ; IgA Vasculitis - epidemiology ; Immunoglobulin A ; Immunologic subjects ; Kidney - pathology ; Male ; Medical research ; Medicine, Experimental ; Nephritis ; Nephritis - diagnosis ; Nephritis - epidemiology ; Pain ; Pediatrics ; Poland - epidemiology ; Population Surveillance ; Registries ; Retrospective Studies ; ROC Curve ; Severity of Illness Index ; Vasculitis</subject><ispartof>Pediatric Rheumatology, 2021-10, Vol.19 (1), p.150-150, Article 150</ispartof><rights>2021. The Author(s).</rights><rights>COPYRIGHT 2021 BioMed Central Ltd.</rights><rights>2021. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>The Author(s) 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c660t-20553fcac0f2413aa15ddf4cc70203bf2e91a49122ccd1ae526a514bd68aeb83</citedby><cites>FETCH-LOGICAL-c660t-20553fcac0f2413aa15ddf4cc70203bf2e91a49122ccd1ae526a514bd68aeb83</cites><orcidid>0000-0003-0063-8699</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8495907/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8495907/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,36990,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34620183$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mizerska-Wasiak, Małgorzata</creatorcontrib><creatorcontrib>Turczyn, Agnieszka</creatorcontrib><creatorcontrib>Cichoń-Kawa, Karolina</creatorcontrib><creatorcontrib>Małdyk, Jadwiga</creatorcontrib><creatorcontrib>Miklaszewska, Monika</creatorcontrib><creatorcontrib>Drożdż, Dorota</creatorcontrib><creatorcontrib>Bieniaś, Beata</creatorcontrib><creatorcontrib>Sikora, Przemysław</creatorcontrib><creatorcontrib>Drożyńska-Duklas, Magdalena</creatorcontrib><creatorcontrib>Żurowska, Aleksandra</creatorcontrib><creatorcontrib>Szczepańska, Maria</creatorcontrib><creatorcontrib>Pańczyk-Tomaszewska, Małgorzata</creatorcontrib><title>IgA vasculitis nephritis clinical course and kidney biopsy - national study in children</title><title>Pediatric Rheumatology</title><addtitle>Pediatr Rheumatol Online J</addtitle><description>The aim of the study was to investigate the relationship between the severity of typical clinical symptoms, severity of histopathological lesions in kidney biopsies in IgA vasculitis nephritis (IgAVN) and to propose indications for kidney biopsy in children.
This retrospective study enrolled 106 patients, included in the IgAVN registry of Polish children, diagnosed by kidney biopsy. Renal and extrarenal symptoms at onset of the disease were analyzed. Biopsy results were assessed using Oxford classifications (MEST-C). The patients were divided into 3 groups depending on the severity of proteinuria: A-nephrotic proteinuria with hematuria; B-non-nephrotic proteinuria with hematuria; C-isolated hematuria.
The first symptoms of nephropathy were observed at the 0.7 (1-128.4) months from the onset of extrarenal symptoms. Kidney biopsy was performed on 39 (6-782) days after the onset of nephropathy symptoms. MEST-C score 4 or 5 was significantly more frequent in children from group A than in groups B and C. Significantly higher mean MEST-C score was found in patients with abdominal symptoms than without. In group A: S0 and T0 we found in significantly shorter time to kidney biopsy than in S1, T1-2 p < 0.05) and in group B the significantly shorter time in T0 compare to T1-2 p < 0.05). The ROC analysis shows that S1 changes appear in kidney biopsies in group A with cut off 21 days (AUC 0,702, p = 0.004, sensitivity 0.895 specificity 0.444) T1-2 changes after 35 days (AUC 0.685, p = 0.022, sensitivity 0.750, specificity 0.615), and in goupn B T1-2 cut off is 74 days (AUC 0,738, p = 0.002, sensitivity 0.667, specificity 0.833).
In childhood IgAVN, the severity of changes in the urine is clearly reflected in the result of a kidney biopsy. The biopsy should be performed in patients with nephrotic proteinuria no later than 3 weeks after the onset of this symptom in order to promptly apply appropriate treatment and prevent disease progression. Accompanying abdominal symptoms predispose to higher MESTC score.</description><subject>Abdomen</subject><subject>Adolescent</subject><subject>Age</subject><subject>Antibodies</subject><subject>Biopsy</subject><subject>Biopsy - methods</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Children</subject><subject>Clinical trials</subject><subject>Creatinine</subject><subject>Development and progression</subject><subject>Disease Progression</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Hematuria</subject><subject>Henoch-Schönlein purpura and other vasculitides</subject><subject>Humans</subject><subject>Hypertension</subject><subject>IgA Vasculitis - diagnosis</subject><subject>IgA Vasculitis - epidemiology</subject><subject>Immunoglobulin A</subject><subject>Immunologic subjects</subject><subject>Kidney - pathology</subject><subject>Male</subject><subject>Medical research</subject><subject>Medicine, Experimental</subject><subject>Nephritis</subject><subject>Nephritis - diagnosis</subject><subject>Nephritis - epidemiology</subject><subject>Pain</subject><subject>Pediatrics</subject><subject>Poland - epidemiology</subject><subject>Population Surveillance</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>ROC Curve</subject><subject>Severity of Illness Index</subject><subject>Vasculitis</subject><issn>1546-0096</issn><issn>1546-0096</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNptUsFuGyEUXFWtmjTtD_RQrVQpymVTHizs7qWSFTWtpUi9ROoRvQXWxsXgwm4k5-uL7TS1q4oD8JgZHsMUxXsg1wCt-JSAdqKrCIWKEAGienxRnAOvRd524uXR-qx4k9KKEM5Jw18XZ6wWlEDLzosf88WsfMCkJmdHm0pvNsu4XylnvVXoShWmmEyJXpc_rfZmW_Y2bNK2rEqPow0-Y9I46W1pfamW1ulo_Nvi1YAumXdP80Vxf_vl_uZbdff96_xmdlcpIchY0dwSGxQqMtAaGCJwrYdaqYZQwvqBmg6w7oBSpTSg4VQgh7rXokXTt-yimB9kdcCV3ES7xriVAa3cF0JcSIyjVc5ISruG9YI1yFnNjW4HgRT6llPWKYaQtT4ftDZTvzZaGT9GdCeipyfeLuUiPMi27nhHmixw9SQQw6_JpFGubVLGOfQmTElS3pKGAINd3x__ga6yy9nJPYoBNJTCX9QC8wOsH0K-V-1E5Uw0LWOMNDvU9X9QeWiztip4M9hcPyFcHhGWBt24TMFNu79Mp0B6AKoYUopmeDYDiNxFUB4iKHME5T6C8jGTPhzb-Ez5kzn2GwvA1Rk</recordid><startdate>20211007</startdate><enddate>20211007</enddate><creator>Mizerska-Wasiak, Małgorzata</creator><creator>Turczyn, Agnieszka</creator><creator>Cichoń-Kawa, Karolina</creator><creator>Małdyk, Jadwiga</creator><creator>Miklaszewska, Monika</creator><creator>Drożdż, Dorota</creator><creator>Bieniaś, Beata</creator><creator>Sikora, Przemysław</creator><creator>Drożyńska-Duklas, Magdalena</creator><creator>Żurowska, Aleksandra</creator><creator>Szczepańska, Maria</creator><creator>Pańczyk-Tomaszewska, Małgorzata</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><general>BMC</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>AAENX</scope><scope>AAFGM</scope><scope>ABUWG</scope><scope>ADAJB</scope><scope>ADZZV</scope><scope>AFCXM</scope><scope>AFKRA</scope><scope>AGAJT</scope><scope>AGBVP</scope><scope>AQTIP</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQCXX</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0003-0063-8699</orcidid></search><sort><creationdate>20211007</creationdate><title>IgA vasculitis nephritis clinical course and kidney biopsy - national study in children</title><author>Mizerska-Wasiak, Małgorzata ; Turczyn, Agnieszka ; Cichoń-Kawa, Karolina ; Małdyk, Jadwiga ; Miklaszewska, Monika ; Drożdż, Dorota ; Bieniaś, Beata ; Sikora, Przemysław ; Drożyńska-Duklas, Magdalena ; Żurowska, Aleksandra ; Szczepańska, Maria ; Pańczyk-Tomaszewska, Małgorzata</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c660t-20553fcac0f2413aa15ddf4cc70203bf2e91a49122ccd1ae526a514bd68aeb83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Abdomen</topic><topic>Adolescent</topic><topic>Age</topic><topic>Antibodies</topic><topic>Biopsy</topic><topic>Biopsy - methods</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Children</topic><topic>Clinical trials</topic><topic>Creatinine</topic><topic>Development and progression</topic><topic>Disease Progression</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Hematuria</topic><topic>Henoch-Schönlein purpura and other vasculitides</topic><topic>Humans</topic><topic>Hypertension</topic><topic>IgA Vasculitis - diagnosis</topic><topic>IgA Vasculitis - epidemiology</topic><topic>Immunoglobulin A</topic><topic>Immunologic subjects</topic><topic>Kidney - pathology</topic><topic>Male</topic><topic>Medical research</topic><topic>Medicine, Experimental</topic><topic>Nephritis</topic><topic>Nephritis - diagnosis</topic><topic>Nephritis - epidemiology</topic><topic>Pain</topic><topic>Pediatrics</topic><topic>Poland - epidemiology</topic><topic>Population Surveillance</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>ROC Curve</topic><topic>Severity of Illness Index</topic><topic>Vasculitis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mizerska-Wasiak, Małgorzata</creatorcontrib><creatorcontrib>Turczyn, Agnieszka</creatorcontrib><creatorcontrib>Cichoń-Kawa, Karolina</creatorcontrib><creatorcontrib>Małdyk, Jadwiga</creatorcontrib><creatorcontrib>Miklaszewska, Monika</creatorcontrib><creatorcontrib>Drożdż, Dorota</creatorcontrib><creatorcontrib>Bieniaś, Beata</creatorcontrib><creatorcontrib>Sikora, Przemysław</creatorcontrib><creatorcontrib>Drożyńska-Duklas, Magdalena</creatorcontrib><creatorcontrib>Żurowska, Aleksandra</creatorcontrib><creatorcontrib>Szczepańska, Maria</creatorcontrib><creatorcontrib>Pańczyk-Tomaszewska, Małgorzata</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>Pediatric Rheumatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mizerska-Wasiak, Małgorzata</au><au>Turczyn, Agnieszka</au><au>Cichoń-Kawa, Karolina</au><au>Małdyk, Jadwiga</au><au>Miklaszewska, Monika</au><au>Drożdż, Dorota</au><au>Bieniaś, Beata</au><au>Sikora, Przemysław</au><au>Drożyńska-Duklas, Magdalena</au><au>Żurowska, Aleksandra</au><au>Szczepańska, Maria</au><au>Pańczyk-Tomaszewska, Małgorzata</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>IgA vasculitis nephritis clinical course and kidney biopsy - national study in children</atitle><jtitle>Pediatric Rheumatology</jtitle><addtitle>Pediatr Rheumatol Online J</addtitle><date>2021-10-07</date><risdate>2021</risdate><volume>19</volume><issue>1</issue><spage>150</spage><epage>150</epage><pages>150-150</pages><artnum>150</artnum><issn>1546-0096</issn><eissn>1546-0096</eissn><abstract>The aim of the study was to investigate the relationship between the severity of typical clinical symptoms, severity of histopathological lesions in kidney biopsies in IgA vasculitis nephritis (IgAVN) and to propose indications for kidney biopsy in children.
This retrospective study enrolled 106 patients, included in the IgAVN registry of Polish children, diagnosed by kidney biopsy. Renal and extrarenal symptoms at onset of the disease were analyzed. Biopsy results were assessed using Oxford classifications (MEST-C). The patients were divided into 3 groups depending on the severity of proteinuria: A-nephrotic proteinuria with hematuria; B-non-nephrotic proteinuria with hematuria; C-isolated hematuria.
The first symptoms of nephropathy were observed at the 0.7 (1-128.4) months from the onset of extrarenal symptoms. Kidney biopsy was performed on 39 (6-782) days after the onset of nephropathy symptoms. MEST-C score 4 or 5 was significantly more frequent in children from group A than in groups B and C. Significantly higher mean MEST-C score was found in patients with abdominal symptoms than without. In group A: S0 and T0 we found in significantly shorter time to kidney biopsy than in S1, T1-2 p < 0.05) and in group B the significantly shorter time in T0 compare to T1-2 p < 0.05). The ROC analysis shows that S1 changes appear in kidney biopsies in group A with cut off 21 days (AUC 0,702, p = 0.004, sensitivity 0.895 specificity 0.444) T1-2 changes after 35 days (AUC 0.685, p = 0.022, sensitivity 0.750, specificity 0.615), and in goupn B T1-2 cut off is 74 days (AUC 0,738, p = 0.002, sensitivity 0.667, specificity 0.833).
In childhood IgAVN, the severity of changes in the urine is clearly reflected in the result of a kidney biopsy. The biopsy should be performed in patients with nephrotic proteinuria no later than 3 weeks after the onset of this symptom in order to promptly apply appropriate treatment and prevent disease progression. Accompanying abdominal symptoms predispose to higher MESTC score.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>34620183</pmid><doi>10.1186/s12969-021-00616-z</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0003-0063-8699</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Abdomen Adolescent Age Antibodies Biopsy Biopsy - methods Child Child, Preschool Children Clinical trials Creatinine Development and progression Disease Progression Female Follow-Up Studies Hematuria Henoch-Schönlein purpura and other vasculitides Humans Hypertension IgA Vasculitis - diagnosis IgA Vasculitis - epidemiology Immunoglobulin A Immunologic subjects Kidney - pathology Male Medical research Medicine, Experimental Nephritis Nephritis - diagnosis Nephritis - epidemiology Pain Pediatrics Poland - epidemiology Population Surveillance Registries Retrospective Studies ROC Curve Severity of Illness Index Vasculitis |
| title | IgA vasculitis nephritis clinical course and kidney biopsy - national study in children |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-02T23%3A56%3A42IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_doaj_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=IgA%20vasculitis%20nephritis%20clinical%20course%20and%20kidney%20biopsy%20-%20national%20study%20in%20children&rft.jtitle=Pediatric%20Rheumatology&rft.au=Mizerska-Wasiak,%20Ma%C5%82gorzata&rft.date=2021-10-07&rft.volume=19&rft.issue=1&rft.spage=150&rft.epage=150&rft.pages=150-150&rft.artnum=150&rft.issn=1546-0096&rft.eissn=1546-0096&rft_id=info:doi/10.1186/s12969-021-00616-z&rft_dat=%3Cgale_doaj_%3EA678333071%3C/gale_doaj_%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c660t-20553fcac0f2413aa15ddf4cc70203bf2e91a49122ccd1ae526a514bd68aeb83%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2583117221&rft_id=info:pmid/34620183&rft_galeid=A678333071&rfr_iscdi=true |