[Clinical and pathological features of children with immunoglobulin A vasculitis with nephritis accompanied by different proportions of crescent formation].

Abstract

Objectives: To investigate the impact of the different proportions of crescent formation on clinical manifestations and pathological features in children with immunoglobulin A vasculitis with nephritis (IgAVN).

Methods: The children with IgAVN were divided into no-crescent group (75 children), ≤25% crescent group (156 children), and >25% crescent group (33 children).

Results: Compared with the no-crescent group, the other two groups had significant increases in 24-hour urinary protein, urinary immunoglobulin G (IgG)/creatinine ratio, urine red blood cell count, fibrinogen, and neutrophil-lymphocyte ratio, a significant reduction in serum IgG, and a significantly higher proportion of children with low albumin and hypercoagulability, pathological grade III+IV or diffuse mesangial proliferation (P<0.05). Compared with the ≤25% crescent group, the >25% crescent group had significant increases in 24-hour urinary protein, urine red blood cell count, and fibrinogen, significant reductions in serum IgG and glomerular filtration rate, and a significantly higher proportion of children with diffuse mesangial proliferation, tubular atrophy or interstitial fibrosis (P<0.05). Compared with the no-crescent group, the >25% crescent group had significantly higher levels of total cholesterol, triglycerides, urea nitrogen, and serum creatinine (P<0.05). A reduction in serum IgG, hypercoagulability, an increase in 24-hour urinary protein, diffuse mesangial proliferation, and chronic tubulointerstitial lesions were influencing factors for the increase in the proportion of crescent formation (P<0.05).

Conclusions: For children with IgAVN, the higher proportion of crescent formation is associated with greater abnormalities in laboratory markers and more severe chronic tubulointerstitial lesions, and thus a detailed analysis of the proportion of crescent formation can better guide clinical treatment.