Gastrointestinal involvement and its association with the risk for nephritis in IgA vasculitis

Mario Sestan; Nastasia Kifer; Marijan Frkovic; Matej Sapina; Sasa Srsen; Mateja Batnozic Varga; Aleksandar Ovuka; Martina Held; Ana Gudelj Gracanin; Ana Kozmar; Stela Bulimbasic; Marijana Coric; Gordana Laskarin; Alenka Gagro; Marija Jelusic

doi:10.1177/1759720X211024828

Gastrointestinal involvement and its association with the risk for nephritis in IgA vasculitis

Ther Adv Musculoskelet Dis. 2021 Jun 30:13:1759720X211024828. doi: 10.1177/1759720X211024828. eCollection 2021.

Authors

Affiliations

¹ Department of Paediatrics, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.
² Department of Paediatrics, Josip Juraj Strossmayer University of Osijek, Medical Faculty and Faculty of Dental Medicine and Health Osijek, University Hospital Centre Osijek, Osijek, Croatia.
³ Department of Paediatrics, University of Split School of Medicine, University Hospital Centre Split, Split, Croatia.
⁴ Department of Paediatrics, Josip Juraj Strossmayer University of Osijek, Medical Faculty Osijek, University Hospital Centre Osijek, Osijek, Croatia.
⁵ Department of Paediatrics, University of Rijeka, Faculty of Medicine, University Hospital Centre Rijeka, Rijeka, Croatia.
⁶ University of Zagreb School of Medicine, Zagreb, Croatia.
⁷ Clinical Department of Laboratory Diagnostics, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.
⁸ Department of Pathology and Cytology, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.
⁹ University of Rijeka, Faculty of Medicine, Rijeka, Croatia.
¹⁰ Department of Paediatrics, Children's Hospital Zagreb, Zagreb, Croatia.
¹¹ Department of Paediatrics, University of Zagreb School of Medicine, Division of Clinical Immunology, Rheumatology and Allergology, Centre of Reference for Paediatric and Adolescent Rheumatology of Ministry of Health of the Republic Croatia, University Hospital Centre Zagreb, Kispaticeva 12, Zagreb, 10 000, Croatia.

Abstract

Background: We analysed clinical and biochemical parameters in predicting severe gastrointestinal (GI) manifestations in childhood IgA vasculitis (IgAV) and the risk of developing renal complications.

Methods: A national multicentric retrospective study included children with IgAV reviewed in five Croatian University Centres for paediatric rheumatology in the period 2009-2019.

Results: Out of 611 children, 281 (45.99%) had at least one GI manifestation, while 42 of 281 (14.95%) had the most severe GI manifestations. Using logistic regression several clinical risk factors for the severe GI manifestations were identified: generalized rash [odds ratio (OR) 2.09 (95% confidence interval (CI) 1.09-4.01)], rash extended on upper extremities (OR 2.77 (95% CI 1.43-5.34)] or face [OR 3.69 (95% CI 1.42-9.43)] and nephritis (IgAVN) [OR 4.35 (95% CI 2.23-8.50)], as well as lower values of prothrombin time (OR 0.05 (95% CI 0.01-0.62)], fibrinogen [OR 0.45 (95% CI 0.29-0.70)] and IgM [OR 0.10 (95% I 0.03-0.35)]] among the laboratory parameters. Patients with severe GI involvement more frequently had relapse of the disease [OR 2.14 (CI 1.04-4.39)] and recurrent rash [OR 2.61 (CI 1.27-5.38)]. Multivariate logistic regression found that the combination of age, GI symptoms at the beginning of IgAV and severity of GI symptoms were statistically significant predictors of IgAVN. Patients in whom IgAV has started with GI symptoms [OR 6.60 (95% CI 1.67-26.06)], older children [OR 1.22 (95% CI 1.02-1.46)] with severe GI form of IgAV (OR 5.90 (95% CI 1.12-31.15)] were particularly high-risk for developing IgAVN.

Conclusion: We detected a group of older children with the onset of GI symptoms before other IgAV symptoms and severe GI form of the IgAV, with significantly higher risk for acute and chronic complications of IgAV.

Keywords: IgA vasculitis; IgA vasculitis nephritis; gastrointestinal manifestations; risk factors.