Factors affecting renal involvement in immunoglobulin A vasculitis

Year 2023, Volume: 28 Issue: 2, 176 - 185, 23.05.2023

Nimet Öner , Serkan Coşkun , Tuba Kurt , Vildan Güngörer , Elif Çelikel , Zahide Ekici Tekin , Nilüfer Tekgöz , Müge Sezer , Cüneyt Karagöl , Melike Mehveş Kaplan , Merve Cansu Polat , Özlem Yüksel Aksoy , Umut Selda Bayrakçı , Banu Acar

https://doi.org/10.21673/anadoluklin.1221278

Abstract

Aim: The aim of this study was to evaluate the factors affecting the duration of renal involvement in children with immunoglobulin A vasculitis (IgAV; formerly Henoch Schonlein Purpura).

Methods: Data from IgAV patients who were followed up on for at least a year between January 2015 and June 2022 were analyzed retrospectively. Demographic, clinical, laboratory findings and treatments were recorded.

Results: The study included 372 IgAV patients, 81 of whom had IgAV kidney involvement. Forty-six (56.8%) of the patients were male and 35 (43.2%) were female. All patients had skin involvement, 32 (39.5%) had joint involvement, 44 (54.3%) had gastrointestinal (GI) tract involvement, and 2 (2.5%) had neurologic involvement. 3 patients had hypertension at the time of diagnosis. Renal involvement was diagnosed at the time of diagnosis in 45 patients (55.5%), within the first 2 weeks in 10 patients (12.4%), between weeks 2-4 in 12 patients (14.8%), and between 1 month and 3 months in 14 patients (17.3%). After 3 months, there was no renal involvement. Renal involvement at the time of diagnosis was associated with older age and low albumin level, and renal involvement at 1-3 months was associated with joint and GI tract involvement. Among patients with renal involvement, those with renal involvement and nephrotic proteinuria at diagnosis had longer time to recovery. Patients with renal involvement and hematuria between 1-3 months had a shorter time to recovery.

Conclusion: The development of IgAV-renal involvement in older age and those with low albumin levels should be carefully monitored. Especially the first 3 months is a risky period in terms of development of renal involvement.

Keywords

Child, immunoglobulin A, proteinuria

İmmünoglobulin A vaskülitinde böbrek tutulumunu etkileyen faktörler

Abstract

Amaç: Bu çalışmada immünglobulin A vasküliti İmmünoglobulin A vasküliti (IgAV; eski adıyla Henoch Schonlein Purpurası) olan çocuklarda böbrek tutulumunun zamanını etkileyen faktörlerin ortaya konulması amaçlanmıştır.

Yöntemler: Ocak 2015- Haziran 2022 arasında IgAV tanısı ile en az 1 yıl takip edilen hastaların verileri geriye dönük olarak incelendi. Hastaların demografik, klinik, laboratuar verileri ve uygulanan tedaviler kaydedildi.

Bulgular: Çalışmaya 372 IgAV hastası dahil edildi, bu hastaların 81’inde IgAV böbrek tutulumu vardı. Hastaların 46’sı (%56,8) erkek, 35’i (%43,2) kızdı. Hastaların tamamında cilt tutulumu, 32’sinde (%39,5) eklem, 44’ünde (%54,3) gastrointestinal sistem (GİS), 2’sinde (%2,5) nörolojik tutulum vardı. 3 hastada tanı anında hipertansiyon vardı. Böbrek tutulumu, 45 hastada (%55,5) tanı anında, 10 hastada (%12,4) ilk 2 hafta içinde, 12 hastada (%14,8) 2-4. haftalar arasında, 14 hastada (%17,3) 1 ay-3 ay arasında saptandı. 3 aydan sonra böbrek tutulumu olmadı. Tanı anında böbrek tutulumu ile tanı yaşının büyük ve albümin düzeyinin düşük olması; 1-3 ayda böbrek tutulumu gelişmesi ile eklem ve GİS tutulumu arasında ilişki bulundu. Böbrek tutulumu olan hastalar içinde iyileşme süresi en uzun olanlar, tanı anında böbrek tutulumu saptananlar ve nefrotik düzeyde proteinüri olan hastalardı. İyileşme süresi en kısa olanlar ise, 1-3 ay arası böbrek tutulumu olan ve hematüri saptananlardı.

Sonuç: Büyük yaştaki çocuklarda ve düşük albümin düzeyi olanlarda IgAV-böbrek tutulumunun gelişimi dikkatle takip edilmelidir. Özellikle ilk 3 ay böbrek tutulumunun saptanması için riskli dönemdir.

Keywords

Çocuk, immünglobulin A, proteinüri

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