Clinical and pathological manifestations of 62 patients with Henoch-Schonlein Purpura nephritis

Objective To analyze the clinical manifestations and pathological features of Henoch-Schonlein purpura nephritis patients. Methods The clinical data of 62 patients with purpura nephritis were analyzed restrospectively. And the clinical manifestations, the grade and distributions of renal pathology were analyzed. Results Patients were divided into the nephritic syndrome group, hematuria combined with proteinuria group, simple hematuria group, and the simple proteinuria group. The serum creatinin level was significantly different between the hephritic syndrome group and the hematuria combined with proteinuria group, the simple hematuris group and proteinuria group[(79±32)μmol/L], the simple hematuria or simple proteinuria group [(81±24)μmol/L], but the nephrotic syndrome group[(203±132) μmol/L], but there was no significant difference in serum C3 level, ESR and IgA level between the groups. The most common pathological manifestations were Grade Ⅱ(12 cases) and Grade Ⅲa(16 cases) in patients with hematuria combined with proteinuria group. Four patients were in Grade Ⅳ. For patients with simple hematuria or proteinuria, the most common pathological features were Grade Ⅱ and Ⅲb(4 cases for each), Grade Ⅲa in 2 and Grade Ⅳa in another 2 patients. Grade Ⅲa and Ⅳa(4 cases for each) were the most predominant pathological presentations for patients with nephritic syndrome, in which Grade Ⅲb, Ⅳb and Ⅴ for 2 respectively, and grade Ⅳ for 4 patients. Eight patients progressed to renal failure in the hephritic syndrome patients. Therefore, the pathological changes of patients with hephritic syndrome were more severe when compared to other groups. Conclusions The clinical presentations as well as pathological changes are protean in adult Henoch-Schonlein purpura nephritis compared to childhood Henoch Schonlein purpura. Serum creatinin level and proteinuria can reflect the severity of the disease in some extent. Nephritic syndrome and crescent formation in the glomerula are poor prognostic factors.