Role of mesangial fibrinogen deposition in the pathogenesis of crescentic Henoch-Schonlein nephritis in children.
OBJECTIVE
To clarify the role of mesangial fibrinogen deposition in crescentic Henoch-Schönlein nephritis (HSN).


METHODS
A retrospective analysis of 21 children with HSN treated with immunosuppressants. Serial renal biopsies were performed before and after treatment. They were divided into two groups according to the immunofluorescent course of fibrinogen deposition: group I (n = 9), no or decreased deposition; group II (n = 12), persistent or increased deposition.


RESULTS
There were no differences between the two groups in renal manifestations or laboratory and histological findings at presentation. However, the activity index after immunosuppressive treatment was significantly decreased in group I (mean, 7.9 (SEM, 0.7) v 2.9 (0.4); p = 0.008) and unchanged in group II (mean, 6.8 (SEM, 0.3) v 6.0 (2.1)). The chronicity index was unchanged in group I, but increased in group II (mean, 0.8 (SEM, 0.3) v 1.8 (0.3); p = 0.02). Univariate analysis revealed that the only factor significantly related to persistent or increased fibrinogen deposition was age more than 9 years (p = 0.03). Furthermore, the intensity of fibrinogen deposition at the second biopsy correlated positively with the age at onset (R2= 0.306; p = 0.009) and changes in the percentage of crescents (post-treatment crescents (%) minus pretreatment crescents (%)) correlated positively with the intensity of fibrinogen deposition at the second biopsy (R2= 0.193; p = 0.046).


CONCLUSIONS
This study indicates that fibrinogen deposition has an important role to play in renal injury of crescentic HSN and reflects persistent severe histological activity.
Shin
J I
JI
The Institute of Kidney Disease, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
Park
J M
JM
Shin
Y H
YH
Lee
J S
JS
Jeong
H J
HJ
D017668:Age of Onset; D000704:Analysis of Variance; D001379:Azathioprine / Q000627:therapeutic use; D001706:Biopsy; D002648:Child; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D005920:Glomerular Mesangium / Q000378:metabolism*; D006801:Humans; D011695:IgA Vasculitis / Q000188:drug therapy / Q000378:metabolism* / Q000473:pathology; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D005340:Fibrinogen; D001379:Azathioprine