Allergic purpura, a common disease that endangers children's health, is prone to recurrent and concurrent multiple diseases, and can progress to renal failure if not treated properly. How to diagnose and effectively conduct comprehensive prevention and control? A recent scientific research achievement that won the second prize of the 2017 Zhejiang Science and Technology Progress Award gave the answer.
The project leader, Professor Mao Jianhua, director of the Renal Urology Center of Children's Hospital of Zhejiang University School of Medicine, introduced that there are three major problems with allergic purpura. First, the specific pathogenesis is unknown, and it cannot provide effective evidence for specific and precise individualized treatment. Second, the early diagnosis of atypical anaphylactoid purpura and severe purpura nephritis is difficult. Third, there are few international and domestic regulations on child purpura nephritis.
In order to solve these three problems, the researchers conducted a large sample of clinical studies on 9312 children and revealed the genetic and complex pathogenesis of allergic purpura/severe purpura nephritis in children for the first time in the world: the incidence of allergic purpura in China and the West. The rates are significantly different, and some genes related to their pathogenesis have been identified and confirmed. Gene mutations and polymorphisms in some molecules are important risk factors for pathogenesis.
The study was the first to develop an early diagnosis system for children with Henoch-Schonlein purpura/severe purpura nephritis in the country: the use of serum IgA concentrations and other indicators significantly reduced the rate of early misdiagnosis of children with atypical anaphylactoid purpura (from 20% to 7.7%). The use of 24-hour urine protein and morning urinary protein/creatinine ratio significantly improved the early recognition rate of severe purpura nephritis (from 55.4% to 85.1%).
The study established and promoted the comprehensive prevention and treatment of childhood purpura nephritis: comprehensive clinical manifestations, risk factors, renal pathology, and long-term follow-up results. A comprehensive prevention and treatment protocol for children with purpura nephritis was developed to classify and manage children with different forms of purpura nephritis. The average course of purpura nephritis was shortened by about 1.5 years, and the incidence of end-stage renal disease and renal replacement therapy was reduced by 56.4%, which significantly improved the long-term prognosis of children. (Reporter Lu Guifang correspondent Kong Qingqing)
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