title: The ISKDC classification and a new semiquantitative classification for predicting outcomes of Henoch-Schönlein purpura nephritis.
abstract: BACKGROUND
  Histological findings from primary kidney biopsies were correlated with patient outcomes in a national cohort of paediatric Henoch-Schönlein nephritis (HSN) patients.
  
  
  METHODS
  Primary kidney biopsies from 53 HSN patients were re-evaluated using the ISKDC (International Study of Kidney Disease in Children) classification and a modified semiquantitative classification (SQC) that scores renal findings and also takes into account activity, chronicity and tubulointerstitial indices. The ISKDC and SQC classifications were evaluated comparatively in four outcome groups: no signs of renal disease (outcome A, n = 27), minor urinary abnormalities (outcome B, n = 18), active renal disease (outcome C, n = 3) and renal insufficiency, end-stage renal disease or succumbed due to HSN (outcome D, n = 5). For the receiver operating characteristic and logistic regression analyses, outcomes A and B were considered to be favourable and outcomes C and D to be unfavourable. The median follow-up time was 7.3 years.
  
  
  RESULTS
  The patients with an unfavourable outcome (C and D), considered together due to low patient numbers, had significantly higher total biopsy SQC scores and activity indices than those who had a favourable one (groups A and B). The chronicity and tubulointerstitial indices differed significantly only between group C + D and group A. The difference in areas under the curve between the total biopsy SQC scores and ISKDC findings was 0.15 [p = 0.04, normal-based 95% confidence interval (CI) 0.007-0.29, bias-controlled 95% CI -0.004 to 0.28].
  
  
  CONCLUSIONS
  Our results suggest that the modified SQC is more sensitive than ISKDC classification for predicting the outcome in HSN cases.
authors.affiliation: Department of Pediatric Nephrology and Transplantation, Children's Hospital, Helsinki University Hospital and University of Helsinki, PO Box 281, 00029, Helsinki, Finland. mikael.koskela@helsinki.fi.
authors.forename: Mikael
authors.initials: M
authors.lastname: Koskela
authors.affiliation: Department of Pediatric Nephrology and Transplantation, Children's Hospital, Helsinki University Hospital and University of Helsinki, PO Box 281, 00029, Helsinki, Finland.
authors.forename: Elisa
authors.initials: E
authors.lastname: Ylinen
authors.affiliation: Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland.
authors.forename: Elli-Maija
authors.initials: EM
authors.lastname: Ukonmaanaho
authors.affiliation: Medical Research Center Oulu and Department of Pathology, Oulu University Hospital, Oulu, Finland.
authors.forename: Helena
authors.initials: H
authors.lastname: Autio-Harmainen
authors.affiliation: Department of Pathology, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Päivi
authors.initials: P
authors.lastname: Heikkilä
authors.affiliation: Department of Pathology, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Jouko
authors.initials: J
authors.lastname: Lohi
authors.affiliation: Department of Pediatrics, Hyvinkää Hospital, Hyvinkää, Finland.
authors.forename: Outi
authors.initials: O
authors.lastname: Jauhola
authors.affiliation: Oulu City Health Care Centre, Oulu, Finland.
authors.forename: Jaana
authors.initials: J
authors.lastname: Ronkainen
authors.affiliation: Department of Pediatric Nephrology and Transplantation, Children's Hospital, Helsinki University Hospital and University of Helsinki, PO Box 281, 00029, Helsinki, Finland.
authors.forename: Timo
authors.initials: T
authors.lastname: Jahnukainen
authors.affiliation: Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland.|Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology (PEDEGO Research Unit), Medical Reasearch Center Oulu (MRC Oulu), Oulu, Finland.
authors.forename: Matti
authors.initials: M
authors.lastname: Nuutinen
mesh_terms: D000293:Adolescent; D001706:Biopsy; D002648:Child; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D011695:IgA Vasculitis / Q000145:classification / Q000150:complications / Q000473:pathology* / Q000652:urine; D007668:Kidney / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000145:classification / Q000209:etiology / Q000473:pathology* / Q000652:urine; D008297:Male; D009393:Nephritis / Q000145:classification / Q000209:etiology / Q000473:pathology* / Q000652:urine; D011379:Prognosis; D011507:Proteinuria / Q000209:etiology / Q000473:pathology* / Q000652:urine; D012372:ROC Curve; D012189:Retrospective Studies
keywords: Children; Glomerulonephritis; Histology; Renal biopsy; Semiquantitative; Vasculitis