Immune complex vasculitis of small vessels with secondary glomerulonephritis in children

Abstract

Immunoglobulin A - vasculitis (IgA-V) is a systemic disease with predominant damage to the microcirculatory channel of the skin, gastrointestinal tract, joints, and kidneys.

Aim - to show, on the basis of clinical observation, the features of the symptoms and course of IgA-V when the kidneys are involved in the pathological process and the complications of treatment.

Clinical case. A 5-year-old child hospitalized with a diagnosis of acute IgA-V of moderate severity: skin, joint, abdominal forms. Bed rest, symptomatic and supportive therapy were prescribed, antigenic load was excluded, pain syndrome was controlled with acetaminophen. Positive dynamics of clinical syndromes were observed. However, against the background of bed rest on the 17th day of the illness, fresh and changed erythrocytes appeared in the morning urine, covering the entire field of vision, erythrocyte cylinders (up to 30-40), protein - 0.9 g/l. In daily urine - protein - 2.0 g/day. The absence of an increase in blood pressure (BP), edema allowed to document the isolated urinary syndrome of secondary glomerulonephritis. Taking into account the severity of the urinary syndrome, prednisolone 1 mg/kg was added to the treatment complex. The lack of effectiveness of corticosteroid for 3 weeks led to the use of plasmapheresis in the children's clinic named “Protection of motherhood and childhood”, after which the number of erythrocytes decreased to 50-80 in the field of vision, erythrocyte cylinders (to 5-8). The daily protein level is up to 1.5 g/day. The child was transferred to the nephrology department, where angiotensin-converting enzyme inhibitors were prescribed under BP control against the background of corticosteroid withdrawal. Observation of the child for 3 years showed periodic exacerbations of vasculitis, which occurred against the background of acute respiratory diseases, which were manifested by a slight hemorrhagic rash on the lower extremities and changes in urine tests. The patient's BP was within normal limits. During the last year of observation, there were no exacerbations of glomerulonephritis and no skin rashes were observed.

Conclusions. IgA - vasculitis involving the kidneys in the form of hematuria and proteinuria can have a long course. Treatment of pronounced urinary syndrome should take into account the possibility of insufficient effectiveness of corticosteroid and the need to use other treatment regimens that depend on the severity of the pathological process in the kidneys. Renoprotection with angiotensin-converting enzyme inhibitors prevents secondary kidney damage.

The research was carried out in accordance with the principles of the Declaration of Helsinki. Informed consent of the child's parents was obtained for the research.

The authors declare no conflicts of interest.