Modern features of the evolution of IgA-vasculitis in children according to catamestic study
Abstract
Abstract. There is a tendency to an increase in the frequency of hospitalization of children with mixed forms of IgA-vasculitis with pronounced abdominal syndrome and involvement in the pathological process of the kidneys, which is possibly associated with an increase in the level of comorbid pathology of the gastrointestinal tract, and with a premorbid state of the mucosa membranes of the digestive system. There is a need to study the course and evolution of IgA vasculitis in children with gastrointestinal manifestations in order to improve the diagnostic search, accurate prognosis and create a standardized treatment protocol for IgA vasculitis in children.
Objective. To investigate the clinical and diagnostic manifestations and evolution of IgA vasculitis in children with lesions of the gastrointestinal tract.
Materials and method. The surveys of patients and their parents and retrospective analysis of 58 maps of inpatients with IgA vasculitis and digestive lesions aged 0 to 18 years, who were hospitalized in the somatic departments of the National Children's Specialized Hospital " OKHMATDYT" Kyiv, Ukraine in the period from 2008 to 2018.
Results. The mean age of children with IgA vasculitis was 8,03 years, and the ratio of boys to girls was 1,32: 1. Skin syndrome occurred in 58/58 patients (100%), and joint symptoms were observed in 34/58 (58,62%) patients. There were 29/58 patients (50,0%) with kidney disease. The incidence of renal pathology was higher in children with severe symptoms of the digestive system and in persons older than 7 years. 23/29 (79,31%) patients had manifestations of kidney damage in the first month after the onset of IgA vasculitis with gastrointestinal symptoms.
Conclusions. In the study among hospitalized children, clinical and laboratory features and the evolution of IgA vasculitis in children with gastrointestinal lesions were similar to the literature. In 79,31% of patients, the onset of renal syndrome occurred in the first month after the onset of IgA vasculitis. In 20,69% of patients there was an evolution of kidney damage into chronic kidney disease. Therefore, careful monitoring of renal impairment should be performed to assess the progression of chronic kidney disease in patients who develop IgA vasculitis over 7 years of age and in those children who have severe symptoms of gastrointestinal damage.
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References
Guy Rostoker. Schönlein-Henoch Purpura in Children and Adults. BioDrugs. 2001;15(2):99-138. DOI: https://doi.org/10.2165/00063030-200115020-00004.
Chiara Rubino, Costanza Monacelli, Edoardo Marrani, Monica Paci, Giuseppe Indolfi, Gabriele Simonini, Sandra Trapani. Gastrointestinal involvement in IgA vasculitis: a single-center 11-year study on a cohort of 118 children. Clin Rheumatol. 2021;40(12):5041-5046. DOI: https://doi.org/10.1007/s10067-021-05863-9.
Vanesa Calvo-Río, Javier Loricera, Cristina Mata, Luis Martín, Francisco Ortiz-Sanjuán, Lino Alvarez et al. Henoch-Schönlein purpura in northern Spain: clinical spectrum of the disease in 417 patients from a single center. Medicine (Baltimore). 2014;93(2):106-113. DOI: https://doi.org/10.1097/MD.0000000000000019.
Yao-Hsu Yanga, Hsin-Hui Yua, Bor-Luen Chiang. The diagnosis and classification of Henoch–Schönlein purpura: An updated review. Autoimmunity Reviews. 2014;13:355-358. DOI: https://doi.org/10.1016/j.autrev.2014.01.031.
Ozen S, Pistorio A, Iusan SM, et al. EULAR/PRINTO/PRES criteria for Henoch–Schönlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II: final classification criteria. Ann Rheum Dis. 2010;69:798–806. DOI: https://doi.org/10.1136/ard.2009.116657.
Outi Jauhola, Jaana Ronkainen, Olli Koskimies, Marja Ala-Houhala, Pekka Arikoski, Tuula Hölttä et al. Clinical course of extrarenal symptoms in Henoch-Schönlein purpura: A 6-month prospective study. Archives of Disease in Childhood. 2010;95(11):871-876. DOI: https://doi.org/10.1136/adc.2009.167874.
Jung Ok Shim, Kyoungdo Han, Sanghyun Park, Gun-Ha Kim Jae Sung Ko, Ju-Young Chung. The Korean Academy of Medical Sciences. Ten-year Nationwide Population-based Survey on the Characteristics of Children with Henoch-Schӧnlein Purpura in Korea. J Korean Med Sci. 2018;33(25):e174. DOI: https://doi.org/10.3346/jkms.2018.33.e174.
Yoon Kang, Jin-su Park, You-Jung Ha, Mi-il Kang, Hee-Jin Park, Sang-Won Lee, Soo-Kon Lee, and Yong-Beom. Differences in Clinical Manifestations and Outcomes between Adult and Child Patients with Henoch Schönlein Purpura. J Korean Med Sci. 2014;29(2):198–203. DOI: https://doi.org/10.3346/jkms.2014.29.2.198.
Yong Hee Lee, Yu Bin Kim, Ja Wook Koo, Ju-Young. Henoch-Schonlein Purpura in Children Hospitalized at a Tertiary Hospital during 2004-2015 in Korea: Epidemiology and Clinical Management. Pediatr Gastroenterol Hepatol Nutr. 2016;19(3):175–185. DOI: https://doi.org/10.5223/pghn.2016.19.3.175.
Han Chan, Yan-Ling Tang, Xiao-Hang Lv, Gao-Fu Zhang, Mo Wang, Hai-Ping Yang, Qiu Li. Risk Factors Associated with Renal Involvement in Childhood Henoch-Schönlein Purpura: A Meta-Analysis. PLoS One. 2016;11(11):e0167346. DOI: https://doi.org/10.1371/journal.pone.0167346.
Sano H, Izumida M, Shimizu H. et al. Risk factors of renal involvement and significant proteinuria in Henoch-Schönlein purpura. Eur J Pediatr. 2002;161,196–201. DOI: https://doi.org/10.1007/s00431-002-0922-z.
Hyun-Jin Choi, Hee-Yeon Cho, Eo-Jin Kim, Byong-Sop Lee, Hee-Gyung Kang, Il-Soo Ha, Hae-Il Cheong, Yong Choi. Prognostic Factors in Children with Henoch-Schonlein Purpura Nephritis. Journal of the Korean Society of Pediatric Nephrology. 2005;9(2):183-192. ID:wpr-184958. http://www.chikd.org/journal/view.php?number=338. [Korean].
Mario Sestan, Nastasia Kifer, Marijan Frkovic, Matej Sapina, Sasa Srsen, Mateja Batnozic Varga et al. Gastrointestinal involvement and its association with the risk for nephritis in IgA vasculitis. Therapeutic Advances in Musculoskeletal Disease. 2021;13:1–13. DOI: https://doi.org/10.1177/1759720x211024828.
Seung Hee Hong, Chan Jong Kim, Eun Mi Yang. Neutrophil-to-lymphocyte ratio to predict gastrointestinal bleeding in Henoch: Schönlein purpura. Pediatr Int. 2018;60(9):791-795. DOI: https://doi.org/10.1111/ped.13652.
Moises A Calderon, Pascal Demoly, Roy Gerth van Wijk, Jean Bousquet, Aziz Sheikh, Anthony Frew et al. EAACI: A European Declaration on Immunotherapy. Designing the future of allergen specific immunotherapy. Clin Transl Allergy. 2012;2(1):20. DOI: https://doi.org/10.1186/2045-7022-2-20.
Peters RL, Krawiec M, Koplin JJ, Santos AF. Update on food allergy. Pediatr Allergy Immunol. 2021;32:647–657. DOI: https://doi.org/10.1111/pai.13443.
Biyan Zhang, Elise Liujake A. Gertie, Julie Joseph, Lan Xu, Elisha Y. Pinker, Daniel A. Waizman. Divergent T follicular helper cell requirement for IgA and IgE production to peanut during allergic sensitization. Science Immunology. 2020;5(47):eaay2754. DOI: https://doi.org/10.1126/sciimmunol.aay2754.
Brendel-Müller K, Hahn A, Schneppenheim R, Santer R. Laboratory signs of activated coagulation are common in Henoch-Schönlein purpura. Pediatr Nephrol. 2001;16(12):1084-8. DOI: https://doi.org/10.1007/s004670100033.
