perinatologyРоссийский вестник перинатологии и педиатрииRossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics)1027-40652500-2228Ltd. “The National Academy of Pediatric Science and Innovation”10.21508/1027-4065-2022-67-6-75-82perinatology-1746Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESСовременный подход к морфологической оценке нефрита при пурпуре Шенлейна-Геноха (IgA-васкулите)A modern approach to the morphological assessment of nephritis in Henoch–Schonlein purpura (IgA-vasculitis)https://orcid.org/0000-0002-1517-0251ПроскураМ. В.ProskuraM. V.

Проскура Мария Владимировна - асп. кафе-дры госпитальной педиатрии им. академика В.А. Таболина

119571 Москва, Ленинский пр., д. 117

Moscow

md.proskura@gmail.comhttps://orcid.org/0000-0002-5160-4512ПетросянЭ. К.PetrosyanE. K.

Петросян Эдита Константиновна - д.м.н., проф. кафедры госпитальной педиатрии им. академика В.А. Таболина

119571 Москва, Ленинский пр., д. 117

Moscow

https://orcid.org/0000-0002-0934-0349ПовилайтитеП. Э.PovilaititeP. E.

Повилайтите Патриция Эдмундовна - к.б.н., врач клинической лабора-торной диагностики высшей категории, зав. отд. высокотехнологичных методов диагностики

344015 Ростов-на-Дону, ул. Благодатная, д. 170 А

Rostov-on-Don

https://orcid.org/0000-0002-0511-8222КушнирБ. Л.KushnirB. L.

Кушнир Берта Леонидовна - врач-патологоанатом Российской детской клинической больницы

119571 Москва, Ленинский пр., д. 117

Moscow

ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава РоссииРоссияPirogov Russian National Research Medical UniversityRussian FederationГБУ РО «Патологоанатомическое бюро»РоссияSBI of Rostov region “Pathology Bureau”Russian Federation2022070120236767582Copyright © Ltd. “The National Academy of Pediatric Science and Innovation”, 20232023Ltd. “The National Academy of Pediatric Science and Innovation”Ltd. “The National Academy of Pediatric Science and Innovation”https://www.ped-perinatology.ru/jour/about/submissions#copyrightNoticehttps://www.ped-perinatology.ru/jour/article/view/1746

Цель исследования. Поиск клинико-морфологических корреляций между проявлениями и исходом нефрита при пурпуре Шенлейна–Геноха, а также оценка влияния морфологических данных на достижение ремиссии в зависимости от классификаций ISKDC, SQC, MEST-C.Материалы и методы. В ретроспективное когортное одноцентровое исследование были включены 32 пациента (15 девочек и 17 мальчиков) с нефритом при пурпуре Шенлейна–Геноха, медиана возраста при поступлении в нефрологическое отделение 9,0 [5; 12] года. У всех детей проанализированы клинические особенности дебюта (возраст, форма дебюта, скорость клубочковой фильтрации, суточная протеинурия, характер гематурии, уровень IgA в сыворотке крови) и течения заболевания. Морфологические данные оценивали при помощи морфологических классификаций ISKDC, SQC, MEST-C. Проводили поиск статистически значимых зависимостей между клинико-морфологическими данными, сравнительный анализ влияния каждой морфологической классификации на достижение ремиссии.Результаты. Общая оценка по шкале SQC статистически значимо влияла на исход (p=0,006): у пациентов с полной ремиссией оценка составила не более 4 баллов, у пациентов, не достигших ремиссии, оценка была на 2 балла больше. При определении вероятности выявления ремиссии в зависимости от оценки по Оксфордской шкале с помощью ROC-анализа была получена статистически значимая модель (p=0,012). При оценке по MEST-C ≤3 баллов прогнозировалась ремиссия (р=0,032). Чувствительность и специфичность метода составили 75%.Заключение. Практическое применение Оксфордской классификации MEST-C и новой полуколичественной классификации SQC, по сравнению с классификацией ISKDC, у детей с нефритом при пурпуре Шенлейна–Геноха перспективно для прогнозирования неблагоприятного исхода почечного заболевания.

The authors analyzed clinical and morphological correlations between the manifestations and outcome in nephritis with Henoch– Schönlein purpura and assessed the effect of morphological data on achieving remission as per ISKDC, SQC, MEST-C classification.Patients and methods. 32 patients with nephritis in Henoch–Schönlein purpura (15 girls and 17 boys) were enrolled into retrospective longitudinal single-center study, median of primary admission to the nephrological department was 9.0 y. o. [5; 12 y.]. Clinical features of the onset (age, form of onset, glomerular filtration rate, daily proteinuria, hematuria, serum IgA level) and the course of the disease were analyzed in all children. The morphological data were assessed using such morphological classifications as ISKDC, SQC, MEST-C. A search for statistically significant relationships between clinical and morphological data and a comparative analysis of the influence of each morphological classification on the achievement of remission were carried out.Results. The sum of the SQC scores had a statistically significant effect on the outcome (p=0.006): in patients with complete remission, on average, 4 points were obtained, patients who did not achieve remission had 2 points more. When assessing the likelihood of detecting remission depending on the total score of the Oxford scale using the ROC-analysis, a statistically significant model was obtained (p=0.012). If the total MEST-C score was less than or equal to 3, remission was predicted (=0.032). The sensitivity and specificity of the method were both 75%.Conclusions. The practical application of the Oxford MEST-C classification and the new semi-quantitative SQC classification in comparison with the ISKDC classification for children with nephritis in Henoch–Schönlein purpura is promising for predicting an unfavorable renal outcome.

детиIgA-васкулитпурпура Шенлейна–ГенохаMEST-CSQCпрогрессированиеchildrenIg A-vasculitisHenoch–Schönlein purpuraMEST-CSQCprogressionReferencesChen J.Y., Mao J.H. Henoch-Schönlein purpura nephritis in children: incidence, pathogenesis and management. World J Pediatr 2015; 11(1): 29–34. DOI: 10.1007/s12519–014–0534–5Chen J.Y., Mao J.H. Henoch-Schönlein purpura nephritis in children: incidence, pathogenesis and management. World J Pediatr 2015; 11(1): 29–34. DOI: 10.1007/s12519–014–0534–5Gardner-Medwin J.M., Dolezalova P., Cummins C., South-wood T.R. Incidence of Henoch-Schönlein purpura, Kawasaki disease, and rare vasculitides in children of different ethnic origins. Lancet 2002; 360: 1197–1202. DOI: 10.1016/S0140–6736(02)11279–7Gardner-Medwin J.M., Dolezalova P., Cummins C., South-wood T.R. Incidence of Henoch-Schönlein purpura, Kawasaki disease, and rare vasculitides in children of different ethnic origins. Lancet 2002; 360: 1197–1202. DOI: 10.1016/S0140–6736(02)11279–7Narchi H. Risk of long-term renal impairment and duration of follow up recommended for Henoch-Schönlein purpura with normal or minimal urinary findings: a systematic review. Arch Dis Child 2005; 90: 916–920. DOI: 10.1136/adc.2005.074641Narchi H. Risk of long-term renal impairment and duration of follow up recommended for Henoch-Schönlein purpura with normal or minimal urinary findings: a systematic review. Arch Dis Child 2005; 90: 916–920. DOI: 10.1136/adc.2005.074641Ronkainen J., Nuutinen M., Koskimies O. The adult kidney 24 years after childhood Henoch–Schönlein purpura: a retrospective cohort study. Lancet 2002; 360: 666–670. DOI: 10.1016/S0140–6736(02)09835–5Ronkainen J., Nuutinen M., Koskimies O. The adult kidney 24 years after childhood Henoch–Schönlein purpura: a retrospective cohort study. Lancet 2002; 360: 666–670. DOI: 10.1016/S0140–6736(02)09835–5Goldstein A.R., White R.H., Akuse R., Chantler C. Long-term follow-up of childhood Henoch–Schönlein nephritis. Lancet 1992; 339: 280–282. DOI: 10.1016/0140–6736(92)91341–5Goldstein A.R., White R.H., Akuse R., Chantler C. Long-term follow-up of childhood Henoch–Schönlein nephritis. Lancet 1992; 339: 280–282. DOI: 10.1016/0140–6736(92)91341–5Counahan R., Winterborn M.H., White R.H., Heaton J.M., Meadow S.R., Bluett N.H. et al. Prognosis of Henoch–Schönlein nephritis in children. Br Med J 1977; 2: 11–14. DOI: 10.1136/bmj.2.6081.262-dCounahan R., Winterborn M.H., White R.H., Heaton J.M., Meadow S.R., Bluett N.H. et al. Prognosis of Henoch–Schönlein nephritis in children. Br Med J 1977; 2: 11–14. DOI: 10.1136/bmj.2.6081.262-dDavin J.C., Coppo R. Henoch–Schönlein purpura nephritis in children. Nat Rev Nephrol 2014; 10: 563–573. DOI: 10.1038/nrneph.2014.126Davin J.C., Coppo R. Henoch–Schönlein purpura nephritis in children. Nat Rev Nephrol 2014; 10: 563–573. DOI: 10.1038/nrneph.2014.126Jelusic M., Sestan M., Cimaz R., Ozen S. Different histological classifications for Henoch–Schönlein purpura nephritis: which one should be used? Pediatr Rheumatol Online J 2019; 17: 10–019–0311-z. DOI: 10.1186/s12969–019–0311-zJelusic M., Sestan M., Cimaz R., Ozen S. Different histological classifications for Henoch–Schönlein purpura nephritis: which one should be used? Pediatr Rheumatol Online J 2019; 17: 10–019–0311-z. DOI: 10.1186/s12969–019–0311-zWorking Group of the International IgA Nephropathy Network and the Renal Pathology Society, Roberts I.S., Cook H.T., Troyanov S., Alpers C.E., Amore A., Barratt J. et al. The Oxford classification of IgA nephropathy: pathology definitions, correlations, and reproducibility. Kidney Int 2009; 76: 546–556. DOI: 10.1038/ki.2009.168Working Group of the International IgA Nephropathy Network and the Renal Pathology Society, Roberts I.S., Cook H.T., Troyanov S., Alpers C.E., Amore A., Barratt J. et al. The Oxford classification of IgA nephropathy: pathology definitions, correlations, and reproducibility. Kidney Int 2009; 76: 546–556. DOI: 10.1038/ki.2009.168Trimarchi H., Barratt J., Cattran D.C., Cook H.T., Coppo R., Haas M. et al. Oxford classification of IgA nephropathy 2016: an update from the IgA nephropathy classification working group. Kidney Int 2017; 91: 1014–1021. DOI: 10.1016/j.kint.2017.02.003Trimarchi H., Barratt J., Cattran D.C., Cook H.T., Coppo R., Haas M. et al. Oxford classification of IgA nephropathy 2016: an update from the IgA nephropathy classification working group. Kidney Int 2017; 91: 1014–1021. DOI: 10.1016/j.kint.2017.02.003Xu K., Zhang L., Ding J., Wang S., Su B., Xiao H. et al. Value of the Oxford classification of IgA nephropathy in children with Henoch–Schönlein purpura nephritis. J Nephrol 2018; 31(2): 279–286. DOI: 10.1007/s40620–017–0457-zXu K., Zhang L., Ding J., Wang S., Su B., Xiao H. et al. Value of the Oxford classification of IgA nephropathy in children with Henoch–Schönlein purpura nephritis. J Nephrol 2018; 31(2): 279–286. DOI: 10.1007/s40620–017–0457-zKoskela M., Ylinen E., Ukonmaanaho E.M., Autio-Harmainen H., Heikkila P., Lohi J. et al. The ISKDC classification and a new semiquantitative classification for predicting outcomes of Henoch–Schönlein purpura nephritis. Pediatr Nephrol 2017; 32: 1201–1209. DOI: 10.1007/s00467–017–3608–5Koskela M., Ylinen E., Ukonmaanaho E.M., Autio-Harmainen H., Heikkila P., Lohi J. et al. The ISKDC classification and a new semiquantitative classification for predicting outcomes of Henoch–Schönlein purpura nephritis. Pediatr Nephrol 2017; 32: 1201–1209. DOI: 10.1007/s00467–017–3608–5Yel S., Dursun I., Pinarbaşi A.S., Günay N., Özdemir S., Şahin N. et al. Patient Outcomes of Henoch-SchönleinPurpura Nephritis According to the New Semiquantitative Classification. Fetal Pediatr Pathol 2020; 39(5): 381–389. DOI: 10.1080/15513815.2019.1658245Yel S., Dursun I., Pinarbaşi A.S., Günay N., Özdemir S., Şahin N. et al. Patient Outcomes of Henoch-SchönleinPurpura Nephritis According to the New Semiquantitative Classification. Fetal Pediatr Pathol 2020; 39(5): 381–389. DOI: 10.1080/15513815.2019.1658245Koskela M., Ylinen E., Autio-Harmainen H., Tokola H., Heik-kiläP., Lohi J. et al. Prediction of renal outcome in Henoch–Schönlein nephritis based on biopsy findings. Pediatr Nephrol 2020; 35(4): 659–668. DOI: 10.1007/s00467–019–04415–3Koskela M., Ylinen E., Autio-Harmainen H., Tokola H., Heik-kiläP., Lohi J. et al. Prediction of renal outcome in Henoch–Schönlein nephritis based on biopsy findings. Pediatr Nephrol 2020; 35(4): 659–668. DOI: 10.1007/s00467–019–04415–3Kim C.H., Lim B.J., Bae Y.S., Kwon Y.E., Kim Y.L., Nam K.H. et al. Using the oxford classification of IgA nephropathy to predict long–term outcomes of Henoch–Schönlein purpura nephritis in adults. Mod Pathol 2013; 27: 972–982. DOI: 10.1038/modpathol.2013.222Kim C.H., Lim B.J., Bae Y.S., Kwon Y.E., Kim Y.L., Nam K.H. et al. Using the oxford classification of IgA nephropathy to predict long–term outcomes of Henoch–Schönlein purpura nephritis in adults. Mod Pathol 2013; 27: 972–982. DOI: 10.1038/modpathol.2013.222Luo X., Tan J., Wan D., Chen J., Hu Y. Predictability of the Oxford classification of IgA nephropathy in Henoch–Schonlein purpura nephritis. IntUrol Nephrol 2022; 54: 99–109. DOI: 10.1007/s11255–021–02861–3Luo X., Tan J., Wan D., Chen J., Hu Y. Predictability of the Oxford classification of IgA nephropathy in Henoch–Schonlein purpura nephritis. IntUrol Nephrol 2022; 54: 99–109. DOI: 10.1007/s11255–021–02861–3Li X., Tang M., Yao X., Zhang N., Fan J., Zhou N. et al.A clinicopathological comparison between IgA nephropathy and Henoch–Schönleinpurpura nephritis in children: use of the Oxford classification. Clin Exp Nephrol 2019; 23(12): 1382–1390. DOI: 10.1007/s10157–019–01777–8Li X., Tang M., Yao X., Zhang N., Fan J., Zhou N. et al.A clinicopathological comparison between IgA nephropathy and Henoch–Schönleinpurpura nephritis in children: use of the Oxford classification. Clin Exp Nephrol 2019; 23(12): 1382–1390. DOI: 10.1007/s10157–019–01777–8

The authors declare that there are no conflicts of interest present.