Henoch-Schönlein purpura nephritis (HSPN), also known as IgA vasculitis-associated nephritis (IgAVN), has a wide variety of clinical manifestations, from isolated microscopic haematuria to nephrotic syndrome, progressive glomerulonephritis, and kidney failure. The results can also vary, and IgAVN treatment is debatable. Nephrotic condition at the beginning of the disease is likely to increase the risk for a bad prognosis. It was not known if patients with nephrotic conditions needed early therapy because not all of them had a poor prognosis.

Researchers studied the clinical outcomes of pediatric IgAVN patients treated at their institution between 2010 and 2018 who had nephrotic status (serum albumin [sAlb]<3.0 g/dL and urine protein-creatinine ratio >2.0 g/gCr) without kidney impairment.

Seventeen of the 216 patients with IgAVN were found to satisfy the criteria for inclusion. From the start of the illness to the last observation, the median follow-up time was 40.5 months (IQR: 31.0-74.2). In the acute phase, the median minimum eGFR was 86.0 mL/min/1.73 m2, the median age at the start was 5 years, the minimum serum Alb level was 1.9 g/dL, and the maximum proteinuria value was 12.3 g/gCr, of the 11 patients who were male. About 8 patients (47%) had full remission without medication by the last assessment and recovered from the nephrotic condition within 3 months. Patients whose nephrotic condition resolved spontaneously tended to have less severe hypoalbuminemia (Alb <2.0 g/dL) and showed a rapid rise in blood albumin levels.

According to the research, half of the children with IgAVN and nephrotic conditions experienced spontaneous remission without medication and had a positive short-term outcome. Kidney biopsies and immunosuppressive medication may be avoided if changes in the blood albumin level and the length of the nephrotic condition are taken into account in children with IgAVN.

Reference: onlinelibrary.wiley.com/doi/10.1111/nep.14041