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Background <p>Corticosteroids are frequently used for extrarenal manifestations of Immunoglobulin A vasculitis (IgAV); however, their impact on the development and phenotypic pattern of kidney involvement remains unclear. We evaluated whether early steroid administration influences the incidence, timing, and phenotypic expression of kidney involvement.</p> Methods <p>We retrospectively analyzed pediatric IgAV patients at a tertiary center (2019–2025). Patients were stratified by whether systemic corticosteroids were administered within 4&#xa0;weeks of extrarenal symptom onset. Outcomes included the incidence, timing, and phenotypic severity of kidney involvement and urinary normalization rates.</p> Results <p>Among 211 patients (median follow-up duration: 2.43 [IQR 0.90–8.33] months), kidney involvement occurred in 20/92 (21.7%) of the steroid-treated and 14/119 (11.8%) of the non-steroid group without significant difference (<i>p</i> = 0.054, odds ratio 2.083, 95% CI 0.988–4.932). The steroid group exhibited significantly higher baseline disease severity, including gastrointestinal (73.9%, 68/92) and joint (67.4%, 62/92) symptoms and higher inflammatory markers, with no significant between-group difference in the median time to kidney involvement (1.03 vs. 0.72&#xa0;months). However, steroid-treated patients were significantly more likely to present with microscopic hematuria and milder proteinuria (50.0% vs. 21.4%, <i>p</i> = 0.021) among kidney phenotypes. Notably, in the moderate proteinuria subgroup, none of the steroid-treated patients achieved full urinary normalization, compared with 75% of the non-steroid group.</p> Conclusions <p>Early corticosteroid treatment for extrarenal IgAV symptoms does not prevent, delay, or mask later kidney involvement. While it may shift the phenotypic expression toward milder hematuria–proteinuria patterns, it may not improve long-term urinary resolution in cases with more severe proteinuria.</p> Graphical abstract <p>A higher resolution version of the Graphical abstract is available as <InternalRef RefID="MOESM1">Supplementary information</InternalRef></p> <p></p>

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Patterns of kidney involvement after corticosteroid treatment for extrarenal symptoms in pediatric IgA vasculitis (Henoch–Schönlein Purpura): phenotypes and outcomes

  • 期刊论文

  • 发表日期：

    2026年7月23日

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  • Da Hyun Kim,
  • Joo Hoon Lee,
  • Jun Sung Park,
  • Jeong-Yong Lee,
  • Seung Jun Choi,
  • Jong Seung Lee,
  • Jiwon Jung

摘要

Background

Corticosteroids are frequently used for extrarenal manifestations of Immunoglobulin A vasculitis (IgAV); however, their impact on the development and phenotypic pattern of kidney involvement remains unclear. We evaluated whether early steroid administration influences the incidence, timing, and phenotypic expression of kidney involvement.

Methods

We retrospectively analyzed pediatric IgAV patients at a tertiary center (2019–2025). Patients were stratified by whether systemic corticosteroids were administered within 4 weeks of extrarenal symptom onset. Outcomes included the incidence, timing, and phenotypic severity of kidney involvement and urinary normalization rates.

Results

Among 211 patients (median follow-up duration: 2.43 [IQR 0.90–8.33] months), kidney involvement occurred in 20/92 (21.7%) of the steroid-treated and 14/119 (11.8%) of the non-steroid group without significant difference (p = 0.054, odds ratio 2.083, 95% CI 0.988–4.932). The steroid group exhibited significantly higher baseline disease severity, including gastrointestinal (73.9%, 68/92) and joint (67.4%, 62/92) symptoms and higher inflammatory markers, with no significant between-group difference in the median time to kidney involvement (1.03 vs. 0.72 months). However, steroid-treated patients were significantly more likely to present with microscopic hematuria and milder proteinuria (50.0% vs. 21.4%, p = 0.021) among kidney phenotypes. Notably, in the moderate proteinuria subgroup, none of the steroid-treated patients achieved full urinary normalization, compared with 75% of the non-steroid group.

Conclusions

Early corticosteroid treatment for extrarenal IgAV symptoms does not prevent, delay, or mask later kidney involvement. While it may shift the phenotypic expression toward milder hematuria–proteinuria patterns, it may not improve long-term urinary resolution in cases with more severe proteinuria.

Graphical abstract

A higher resolution version of the Graphical abstract is available as Supplementary information