What is the role of renal biopsy in the workup of Henoch-Schönlein purpura (IgA vasculitis)?

Updated: Oct 28, 2020
  • Author: Rajendra Bhimma, MBChB, MD, PhD, DCH (SA), FCP(Paeds)(SA), MMed(Natal); Chief Editor: Craig B Langman, MD  more...
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Answer

In some cases, kidney biopsy may be useful. It should be performed when nephrotic syndrome persists (though other manifestations may have subsided) and when kidney function deteriorates. When patients present with nephrotic syndrome, hypertension, and rapidly deteriorating kidney function, biopsy often shows circumferential crescents in most of the glomeruli. The extent of the crescents is of prognostic importance. Approximately 60% of patients develop kidney failure, either in the acute phase of the disease or after several years.

The International Study of Kidney Disease in Children (ISKDC) classification is widely used for patients with IgAV nephritis. [19] Nephritis may be graded as follows:

  • Grade I - Minimal glomerular abnormalities
  • Grade II - Mesangial proliferation without crescents or sclerosing lesions
  • Grade III (a) - Focal segmental mesangial proliferation with < 50% crescents or sclerosing lesions   
  • Grade III (b) - Diffuse mesangial proliferation with < 50% crescents or sclerosing lesions
  • Grade IV - Mesangial proliferation with 50% - 70% crescents or sclerosing lesions
  • Grade V - > 75% crescents or sclerosing lesions
  • Grade VI - Membranoproliferative-like lesions

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