Different histological classifications for Henoch-Schönlein purpura nephritis: which one should be used?

Authors:
Marija Jelusic
Marija Jelusic
University of Zagreb School of Medicine
Mario Sestan
Mario Sestan
University Hospital Centre Zagreb
Rolando Cimaz
Rolando Cimaz
Anna Meyer Children's Hospital and University of Florence
Italy
Seza Ozen
Seza Ozen
Hacettepe University
Turkey

Pediatr Rheumatol Online J 2019 Feb 28;17(1):10. Epub 2019 Feb 28.

Department of Pediatrics, Hacettepe University, Ankara, Turkey.

Background: Nephritis is the most important chronic complication of IgA Vasculitis (IgAV)/Henoch-Schönlein purpura (IGAV/HSP) and thus the main prognostic factor of this most common childhood vasculitis. Since the prognosis and treatment selection depends on the mode of interpretation of biopsy material, in this manuscript we have presented several issues related to the uneven application of different histological classifications in IgAV/Henoch-Schönlein purpura nephritis (HSPN). The nephritis of IgAV/IGAV/HSP will be abbreviated as HSPN for this paper.

Main Body: In clinical practice we use different histological classifications for HSPN. It is not known which of these classifications best correlates with severity of renal disease and renal outcome in IgAV/IGAV/HSP. One of the major problem with existing histological classifications is that there is no consensus on the implementation of biopsy in the treatment of HSPN. There is a histologic classification system conventionally used in HSPN, of the International Study of Kidney Disease in Children (ISKDC). On the other hand there is the new classification system suggested for IgA nephropathy, the Oxford classification. The latter has been validated only in IgA nephropathy. There are also two further histologic classifications of Haas and Koskela that have been developed. Current treatment strategies in HSPN are not standardised nor predominantly based on histological classification.

Conclusion: One of the possible solutions to problems related to the application of different histological classification in HSPN is the implementation of multicenter multinational prospective studies with joint collaboration between pediatric rheumatologists, nephrologists and nephropathologists to correlate the clinical features and outcome with the classification systems as well among the classifications. This classification should be the basis for the construction of guidelines for the treatment of patients with HSPN.

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http://dx.doi.org/10.1186/s12969-019-0311-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6393980PMC
February 2019
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