An Analysis of the Similarities and Differences between IgA Nephropathy and Henoch-Schönlein Purpura Nephritis in Children

随着异常糖基化IgA1在过敏性紫癜性肾炎(HSPN)与IgA肾病(IgAN)致病机制中的关键作用被逐步揭示，以及二者在遗传易感性、肾脏免疫病理和临床表现上既重叠又分化的特征，HSPN与IgAN是否为同一疾病的不同表型已成为国际争议热点。本文结合近年研究进展，系统比较两者的异同：病理上，二者均以Gd-IgA1介导的免疫复合物沉积为核心，表现为系膜增生性肾炎；但HSPN以急性新月体病变和全身性症状(如紫癜、腹痛)为标志，而IgAN以慢性间质纤维化和孤立性肾脏受累为主。临床治疗需根据疾病表型及病理特征差异化干预。未来需深入解析二者分子机制异同，为疾病分型及精准诊疗提供依据。As the role of abnormal glycosylation IgA1 in the pathogenic mechanism of Henoch-Schönlein purpura nephritis (HSPN) and IgA nephropathy (IgAN) has been gradually revealed, along with the overlapping and differentiated features of these diseases in genetic susceptibility, renal immunopathology, and clinical manifestations, whether HSPN and IgAN are different phenotypes of the same disease has become a subject of international controversy. In this article, we systematically compare the similarities and differences between the two in the light of recent research progress. Pathologically, both are characterized by Gd-IgA1-mediated immune complex deposition at the core and manifest as a mesangial proliferative nephritis; however, HSPN is marked by acute crescentic lesions and systemic symptoms (e.g., purpura, abdominal pain), whereas IgAN is characterized by chronic interstitial fibrosis and isolated renal involvement. Clinical treatment needs to be differentiated according to the disease phenotype and pathological features. In the future, it is necessary to deeply analyze the similarities and differences in the molecular mechanisms of the two to provide a basis for disease typing and precise diagnosis and treatment.