Objective: To retrospectively investigate the current diagnosis and treatment of children with Henoch-Schonlein purpura nephritis in hospital, to survey the application of practical evidence-based guidelines in children with Henoch-Schonlein purpura nephritis.
Method: A nationwide survey in 40 hospitals was conducted and data of hospitalized children diagnosed as Henoch-Schonlein purpura nephritis for the first time during the period of 1st July 2008 to 30th June 2011 were analyzed. The collected information included age, gender, disease duration, clinical manifestations, relevant auxiliary examination results, renal biopsy, and treatment and so on. The data were collected and analyzed by the subspecialty group of nephrology, Chinese Society of Pediatrics.
Result: There were 4863 hospitalized children with Henoch-Schonlein purpura nephritis from July 1, 2008 to June 30, 2011 in 40 hospitals. The male (n = 2935) to female (n = 1928) ratio was 1.52: 1, the peak incidence between 6 to 13 years old. Renal impairment occurred in 96.7% (n = 4702) with 6 months from the onset of Henoch-Schonlein purpura. The most common clinical findings were proteinuria and hematuria (2831 patients, 58.2%); 1448 patients received renal biopsy, subclass III and II were the most common histological types; 3677 patients (75.6%) were treated with corticosteroids and immunosuppressants. The most common treatment scheme was corticosteroids only (1655 patients, 34.0%). More than half of the patients (362 patients, 56.2%) with pure hematuria received no corticosteroids or immunosuppressants. Patients with hematuria and proteinuria always received corticosteroids only (1017 patients, 35.9%). Corticosteroids with or without tripterygium glycosides were always given to the patients with subclass I and II in renal biopsy. The patients with subclass III and IV were mainly treated with combination of corticosteroids, cyclophosphamide and methylprednisolone.
Conclusion: The incidence of purpura nephritis has increased; the duration of renal impairment had no correlation with the gender. Compared to the female, the male patients are more likely to have proteinuria. The patients with mild proteinuria also can present with severe renal histological impairment. There was no unified treatment scheme in the immunosuppressants and non-specific drugs. Multi-center randomized controlled trials (RCTs) are needed to explore and manage the treatment of purpura nephritis.