Advances in Clinical and Experimental Medicine
2020, vol. 29, nr 4, April, p. 513–519
doi: 10.17219/acem/112566
Publication type: review article
Language: English
License: Creative Commons Attribution 3.0 Unported (CC BY 3.0)
Download citation:
IgA vasculitis with nephritis in children
1 Department of Pediatric Nephrology, Teaching Hospital No. 1, Medical University of Silesia, Zabrze, Poland
2 Chair and Department of Pediatrics, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Poland
Abstract
Immunoglobulin A vasculitis (IgAV), formerly known as Henoch–Schönlein purpura (HSP), is the most common form of systemic vasculitis in children. Although the first case of IgAV was described more than 200 years ago, its etiology still remains unclear. Nephrological symptoms are observed in 30–50% of children during the course of the disease, and in up to 91% of cases within 6 weeks of the onset of the first symptoms. Whereas other organ manifestations of IgAV are mostly benign and self-limiting, nephritis may lead to chronic kidney disease (CKD) and end-stage renal disease (ESRD). Appropriate treatment commenced early enough can stop the disease progression. However, even in severe cases there are no evidence-based guidelines, which makes the therapeutic decisions more difficult. In this article, which is the most up-to-date overview regarding IgAV, we discuss the disease’s pathogenesis, the clinical forms of renal involvement in the course of the disease, the risk factors for adverse prognosis and treatment options in accordance with current recommendations.
Key words
children, nephritis, immunoglobulin A vasculitis
References (57)
- Gardner-Medwin JM, Dolezalova P, Cummins C, Southwood TR. Incidence of Henoch–Schönlein purpura, Kawasaki disease and rare vasculitides in children of different ethnic origins. Lancet. 2002;360(9341):1197–1202.
- Jannette JC, Falk RJ, et al. 2012 Revised International Chapel Hill Consensus Conference of Nomenclature of Vasculitides. Arthritis Rheum. 2013;65(1):1–11.
- Piram M, Mahr A. Epidemiology of immunoglobulin A vasculitis (Henoch–Schönlein): Current state of knowledge. Curr Opin Rheumatol. 2013;25(2):171–178.
- Piram M, Maldini C, Biscardi S, et al. Incidence of IgA vasculitis in children estimated by four-source capture-recapture analysis: A population-based study. Rheumatology (Oxford). 2017;56(8):1358–1366.
- Saulsbury FT. Henoch–Schönlein purpura in children. Report of 100 patients and review of the literature. Medicine (Baltimore). 1999;78(6):395–409.
- Pohl M. Henoch–Schönlein purpura nephritis. Pediatr Nephrol. 2015;30(2):245–252.
- McCarthy HJ, Tizard EJ. Clinical practice: Diagnosis and management of Henoch–Schönlein purpura. Eur J Pediatr. 2010;169(6):643–650.
- Ozen S, Pistorio A, Iusan SM, et al. EURAL/PRINTO/PRES criteria for Henoch–Schöenlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II: Final classification criteria. Ann Rheum Dis. 2010;69(5):798–806.
- Singhal M, Gupta P, Sharma A. Imaging in small and medium vessel vasculitis. Int J Rheum Dis. 2019;22(Suppl 1):78–85.
- Hwang HH, Lim IS, Choi BS, Yi DY. Analysis of seasonal tendencies in pediatric Henoch–Schönlein purpura and comparison with outbreak of infectious diseases. Medicine (Baltimore). 2018;97(36):e12217.
- Jamrozik A, Sybilski A, Pohorecka M, Patena K. Zespół Schönleina-Henocha – nowe wyzwania diagnostyczne w starej chorobie. Pediatr Med Rodz. 2012;8(3):214–221.
- Calvino MC, Llorca J, Garcia-Porrua C, et al. Henoch–Schonlein purpura in children from northwestern Spain: A 20-year epidemiologic and clinical study. Medicine (Baltimore). 2001;80(5):279–290.
- Masuda M, Nakanishi K, Yoshizawa N, Iijima K, Yoshikawa N. Group A streptococcal antigen in the glomeruli of children with Henoch––Schonelein nephritis. Am J Kidney Dis. 2003;41(2):366–370.
- Yang YH, Wang SJ, Chuang YH, Lin YT, Chiang BL. The level of IgA antibodies to human umbilical vein endothelial cells can be enhanced by TNF-α treatment in children with Henoch–Schönlein purpura. Clin Exp Immunol. 2002;130(2):352–357.
- Grenda R. Nefropatia w przebiegu plamicy Henocha–Schönleina. Nefrol Dial Pol. 2008;12 (3):186–192.
- Davin JC, Ten Berge IJ, Weening JJ. What the difference between IgA nephropathy and Henoch–Schönlein purpura nephritis? Kidney Int. 2001;59(3):823–834.
- Gonzáles-Gay M, López-Mejías R, Pina T, Blanca R, Castaňeda S. IgA vasculitis: Genetics and clinical and therapeutic management. Curr Rheumatol Rep. 2018;20(5):24.
- López-Mejías R, Genre F, Pérez BS, et al. HLA-DRB1 association with Henoch–Schonlein purpura. Arthritis Rheumatol. 2015;67(3):823–827.
- Brogan PA. What’s new in the aetiopathogenesis of vasculitis? Pediatr Nephrol. 2007;22(8):1083–1094.
- Amoli MM, Thomson W, Hajeer AH, et al. HLA-B35 association with nephritis in Henoch–Schönlein purpura. J Rheumatol. 2002;29(5):948–949.
- Brogan P, Eleftheriou D, Dillon M. Small vessel vasculitis. Pediatr Nephrol. 2010;25(6):1025–1035.
- Heineke MH, Ballering AV, Jamin A, Ben Mkaddem S, Monteiro RC, Van Egmond M. New insights in the pathogenesis of immunoglobulin A vasculitis (Henoch–Schönlein purpura). Autoimmunity Rev. 2017;16(12):1246–1253.
- Lau K, Suzuki H, Novak J, Wyatt RJ. Pathogenesis of Henoch–Schönlein purpura nephritis. Pediatr Nephrol. 2010;25(1):19–20.
- Gharavi AG, Moldoveanu Z, Wyatt RJ, et al. Aberrant IgA1 glycosylation is inherited in familial and sporadic IgA nephropathy. J Am Soc Nephrol. 2008;19(5):1008–1014.
- Kiryluk K, Moldoveanu Z, Sanders JT, et al. Aberrant IgA1 glycosylation is inherited in pediatric IgA Nephropathy and in Henoch–Schönlein Purpura nephritis. Kidney Int.2011;80(1):79–87.
- Suzuki H, Raska M, Yamada K, et al. Cytokines alter IgA1 O-glycosylation by disregulating C1GalT1 and ST6GalNAc-II enzymes. J Biol Chem. 2014;289(8):5330–5339.
- Mizerska-Wasiak M, Gajewski Ł, Cichoń-Kawa K, et al. Serum GDIgA1 levels in children with IgA nephropathy and Henoch–Schönlein nephritis. Cent Eur J Immunol. 2018;43(2):162–167.
- Moura IC, Acros-Fajardo M, Sadaka C, et al. Glycosylation and size of IgA1 are essential for interaction with mesangial transferring receptor in IgA nephropathy. J Am Soc Nephrol. 2004;15(3):622–634.
- Haddad E, Moura IC, Arcos-Fajardo M, et al. Enhanced expression of the CD71 mesangial IgA1 receptor in Berger disease and Henoch––Schönlein nephritis: Association between CD71 expression and IgA deposits. J Am Soc Nephrol. 2003;14(2):327–337.
- Lai KN, Leung JC, Chan Ly, et al. Activation of podocytes by mesangial-derived TNF-alpha: glomerulo-podocytic communication in IgA nephropathy. Am J Physiol Renal Physiol. 2008;294(4):F945–F955.
- Yang YH, Chuang YH, Wang LC, Huang HY, Gershwin ME, Chiang BL. The immunobiology of Henoch–Schönlein purpura. Autoimmun Rev. 2008;7(3):179–184.
- Roos A, Bouwman LH, Van Gijlswijk-Janssen DJ, Faber-Krol MC, Stahl GL, Daha MR. Human IgA activates the complement system via the mannan-binding lectin pathway. J Immunol. 2001;167(5):2861–2868.
- Narchi 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(9):916–920.
- Chan H, Tang YL, Lv XH, et al. Risk Factors Associated with renal involvement in childhood Henoch–Schönlein purpura: A meta-analysis. PLoS One. 2016;11(11):e0167346.
- Halling SF, Söderberg MP, Berg UB. Henoch Schonlein nephritis: Clinical findings related to renal function and morphology. Pediatr Nephrol. 2005;20(1):46–51.
- Ronkainen J, Nuutinen M, Koskimies O. The adult kidney 24 years after childhood Henoch–Schönlein purpura: A retrospective cohort study. Lancet. 2002;360(9334):666–670.
- Hara M, Yanagihara T, Kihara I. Cumulative excretion of urinary podocytes reflects disease progression in IgA nephropathy and Schönlein-Henoch purpura nephritis. Clin J Am Soc Nephrol. 2007;2(2):231–238.
- Jelusic 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(1):10.
- Nicoara O, Twombley K. Immunoglobulin A nephropthy and immunoglobulin A vasculitis. Pediatr Clin North Am. 2019;66(1):101–110.
- Huang X, Wu J, Wu XW, et al. Significance of histological crescent formation in patients with IgA vasculitis (Henoch–Schönlein purpura)-related nephritis: A cohort in the adult Chinese population. BMC Nephrol. 2018;19(1):334.
- Davin JC. Henoch–Schönlein purpura nephritis: Pathophysiology, treatment, and future strategy. Clin J Am Soc Nephrol. 2011;6(3):679–689.
- Xu K, Zhang L, Ding J, et al. Value of the Oxford classification of IgA nephropathy in children with Henoch–Schönlein purpura nephritis. J Nephrol. 2018;31(2):279–286.
- Huang X, Ma L, Ren P, et al. Updated Oxford classification and the international study of kidney disease in children classification: Application in predicting outcome of Henoch–Schönlein purpura nephritis. Diagnostic Pathol. 2019; doi:10.1186/s13000-019-0818-0.
- Koskela M, Ylinen E, Ukonmaanaho EM, et al. The ISKDC classification and a new semiquantitative classification for predicting outcomes of Henoch–Schönlein purpura nephritis. Pediatr Nephrol. 2017;32(7):1201–1209.
- Zaffanello M, Fanos V. Treatment-based literature of Henoch–Schönlein purpura nephritis in childhood. Pediatr Nephrol. 2009;24(10):1901–1911.
- Kidney Disease: Improving global outcomes (KDIGO). Henoch––Schönlein purpura. Kidney Int Suppl. 2012(11):218–220.
- Hahn D, Hodson EM, Willis NS, Craig JC. Interventions for preventing and treating kidney disease in Henoch–Schönlein purpura (HSP). Cochrane Database Syst Rev. 2015;7(8):CD005128.
- Dudley J, Smith G, Llewelyn-Edwards A, Bayliss K, Pike K, Tizard J. Randomised, double-blind, placebo-controlled trial to determine whether steroids reduce the incidence and severity of nephropathy in Henoch–Schonlein purpura (HSP). Arch Dis Child. 2013;98(10):756–763.
- Davin JC, Coppo R. Pitfalls in recommending evidence-based guidelines for protean disease like Henoch–Schonlein purpura nephritis. Pediatr Nephrol. 2013;28(10):1897–1903.
- Salewski D, Ambruzs J, Appel G, et el. Clinical characteristics and treatment patterns of children and adults with IgA nephropathy or IgA vasculitis: Findings from CureGN Study. Kidney Int Rep.2018;3(6):1373–1384.
- Koskela M, Jahnukainen T, Endén K, et al. Methylprednisolone or cyclosporine a in the treatment of Henoch–Schönlein nephritis: A nationwide study. Pediatr Nephrol. 2019;34(8):1447–1456.
- Ozen S, Marks SD, Brogan P, et al. European consensus-based recommendations for diagnosis and treatment of immunoglobulin A vasculitis – the SHARE initiative. Rheumatology (Oxford). 2019. doi:10.1093/rheumatology/kez041
- Goldstein AR, White RH, Akuse R, Chantler C. Long-term follow-up of childhood Henoch–Schonlein nephritis. Lancet. 1992;339(8788):280–282.
- Nussinovitch N, Elishkevitz K, Volovitz B, Nussinovitch M. Hypertension as a late sequela of Henoch–Schönlein purpura. Clin Pediatr. 2005;44(6):543–547.
- Audemard-Verger A, Pillebout E, Guillevin L, Thervet E, Terrier B. IgA vasculitis (Henoch–Shönlein purpura) in adults: Diagnostic and therapeutic aspects. Autoimmun Rev. 2015;14(7):579–585.
- Heleniak Z, Dębska-Ślizień A, Ptasińska-Perkowska A, Rutkowski B. Zapalenie naczyń związane z IgA (plamica Henocha-Shönleina) a nerki. Forum Nefro. 2014;7(3):159–168.
- Kanaan N, Mourad G, Thervet E, et al. Recurrence and graft loss after kidney transplantation for Henoch–Schönlein purpura nephritis: A multicenter analysis. Clin J Am Soc Nephrol. 2011;6(7):1768–1772.