Original Article
Mod Pathol 2001;14(7):635–640
Grading of Acute and Chronic Renal Lesions in Henoch-Schönlein Purpura
Cheuk Chun Szeto M.R.C.P.1, Paul C L Choi F.R.C.P.A.2, Ka Fai To F.R.C.P.A.2, Philip K T Li F.R.C.P.1, Joannie Hui F.R.A.C.P.3, Kai Ming Chow M.R.C.P.1, C B Leung M.R.C.P.1, Siu Fai Lui F.R.C.P.1 and Fernand Mac-Moune Lai F.R.C.P.A.2
- 1Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
- 2Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
- 3Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
Correspondence: Fernand Mac-Moune Lai, F.R.C.P.A., Department of Anatomical & Cellular Pathology, Prince of Wales Hospital, Room 34055, Shatin, Hong Kong, China, S.A.R.; e-mail: fmlai@cuhk.edu.hk; fax: 852-2637-6274.
Accepted 5 September 2001.
Abstract
The renal outcome of 34 patients with Henoch-Schönlein purpura nephritis was assessed clinically and by grading acute and chronic renal lesions using a system we applied to primary IgA nephropathy. On a median follow-up period of 65 months, hypertension and the serum levels of creatinine and proteinuria at the time of renal biopsy were correlated with renal survival. Acute glomerular lesions including mesangial hypercellularity, endocapillary proliferation, necrosis, cellular crescents, and leukocytes infiltration were observed, respectively, in 41%, 12%, 50%, 29%, and 32% of the cases. Of these, only glomerular necrotizing lesion and cellular crescent were correlated with the renal survival. Chronic renal lesions based on a grading system applied to primary IgA nephropathy and assessing the extent of glomerular sclerosis (glomerular grading), of tubular loss and interstitial fibrosis (tubulointerstitial grading), and of hyaline arteriolosclerosis demonstrated correlation between these lesions, as well as with renal survival. On follow-up, these chronic renal lesions were predictors of subsequent clinical events associated with disease progression, such as impaired renal function, significant proteinuria, and development of hypertension. Despite some limitations related to the relatively small size, this series indicates that distinction of acute and chronic lesions of Henoch-Schonlein purpura nephritis is important for both the prognosis and management of patients.
Keywords:
Acute renal lesions, Chronicity-based grading, Henoch-Schönlein purpura, Histological grading, Primary IgA nephropathy, Prognosis, Renal biopsy
