Analysis of Prognostic Factors on the Regular Glucocorticoid Combined with Cyclophosphamide Pulse in Children Suffered from Henoch-Schönlein Purpura Nephritis with Nephrotic Proteinuria

Abstract

Background: Henoch Schönlein purpura nephritis (HSPN) with a large amount of proteinuria is a risk factor for poor long-term prognosis. Patients with proteinuria at nephrotic level should be actively treated with glucocorticoids combined with cyclophosphamide. However, there was a lack of research on the influence factors of curative effect. The objective of this study was to evaluate factors affecting curative effect in children with HSPN in proteinuria at nephrotic level treated with glucocorticoids combined with cyclophosphamide. Methods: Demographic factors, clinical characteristics, and laboratory data of children with HSPN with or without proteinuria after glucocorticoid combined with cyclophosphamide pulse were retrospectively analyzed. Univariate and multivariate logistic regression analyses were used to determine the risk factors of curative effect in HSPN with nephrotic proteinuria. Results: A total of 107 children with HSPN in nephrotic proteinuria received their first Cyclophosphamide Pulse as part of this study, which included 63 (58.9%) males and 44 females (41.1%), with a median age of 8 years (range: 3-16 years). According to 24 hours proteinuria after 6th cyclophosphamide pulse, subjects were divided into two groups: those with negative of 24-h urine protein quantification (n=72 cases) and those with positive of 24-h urine protein quantification (n=35 cases). After multivariate logistic regression analysis, 24-h urinary protein exceeded normal level during therapy (OR=8.766; 95% CI; 2.521–30.484; P=0.001), repeated skin purpura during therapy (OR=10.821; 95% CI; 1.678–69.780; P=0.012), macroscopic hematuria during therapy (OR=33.900; 95% CI; 2.201–522.131; P=0.012), history of upper respiratory tract infection during therapy (OR=2.122; 95% CI; 1.152–3.908; P=0.013) and fibrinogen (OR=25.053; 95% CI, 1.354–463.708; P=0.016) were found to be independent risk factors for clinical efficacy of glucocorticoid combined with cyclophosphamide. The area under the ROC (AUC) of the model prediction probability was 0.892, with the Hosmer and Lemeshow goodness-of-fit test (P = 0.433, P > 0.05). Conclusion: These results suggest that during the therapy, 24-h urinary protein exceeded normal level, repeated skin purpura, macroscopic hematuria, history of upper respiratory tract infection and higher fibrinogen should be strictly monitored for children with HSPN. Adequate clinical intervention for these risk factors may improve prognosis.