Age of onset as a risk factor of renal involvement in Henoch-Schönlein purpura

Ghrahani, Reni; Ledika, Masayu Amanda; Sapartini, Gartika; Setiabudiawan, Budi

doi:10.5415/apallergy.2014.4.1.42

Cited by 52 publications

(55 citation statements)

References 10 publications

(35 reference statements)

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“…7,10,23 Our observation of higher frequency of abdominal pain, as the first presenting symptom in children as compared to adults, in whom it only rarely preceded the skin rash, has also been found in other studies (Table 2). 7,12,23 Higher prevalence of joint involvement (arthralgia/ arthritis) in adults as compared to children is in variance with previous data where the frequency has been either similar or increased in children (Table 2).…”

Section: Discussionsupporting

confidence: 64%

“…7,8 Indeed, age at onset has been considered to be a risk factor for severity, renal involvement and recurrence. [9][10][11] Henoch-Sch€ onlein purpura has been extensively studied in children but there is a relative paucity of studies on HSP in adults. 12,13 The lower incidence in adults and the possible impediment in identification of adult HSP cases by the older American College of Rheumatology (ACR) criteria (that included 'age < 20 years at onset' as one of the criteria) may partly explain the paucity of data on adults.…”

Section: Introductionmentioning

confidence: 99%

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Differences between adult and pediatric onset Henoch‐Schonlein purpura from North India

et al. 2017

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Aim: Henoch-Sch€ onlein purpura (HSP), a primary vasculitis, characterized by purpura, abdominal pain, arthritis and renal involvement, is predominantly a disease of childhood. However, rarely it can occur in adults in whom it is believed to be a more severe form with poor renal outcomes. We aimed to answer if the age of onset affected the clinical spectrum and renal outcomes of the disease in a north Indian population. Hence, we studied the differences in clinical spectrum and renal outcomes between adult-onset HSP and childhood-onset HSP.Methods: Case records of all adult patients diagnosed with HSP (onset ≥ 18 years) over the last 25 years in our department were retrieved. Data on clinical features, lab abnormalities and outcomes were extracted and compared with that in pediatric HSP patients (onset < 18 years) seen during the same period.Results: A total of 87 patients, including 30 adults and 57 children, were seen during this period. Compared to children, most of the adults had purpura as the first clinical manifestation (86.7% vs. 56.1%, P < 0.01) whereas abdominal pain was only rarely the initial symptom in adults (10.0% vs. 36.8%, P < 0.02). During the disease course, adults had a higher frequency of joint involvement as compared to children (90.0% vs. 43.9%, P < 0.001). There was no significant difference in the frequency of renal involvement (60.0% vs. 50.9%, P = NS) and gastrointestinal involvement (66.7% vs. 84.2%, P = NS) between adults and children. Outcomes were good in both groups and most adults and children achieved complete recovery (83.3% and 86.0%, respectively). There was no difference in the frequency of immunosuppressive treatment required by the two groups. None of the patients developed renal insufficiency on follow-up. Conclusion:Compared to children, adults with HSP seldom have abdominal pain as the first clinical manifestation while joint involvement is seen more commonly in them during the disease course.

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Section: Discussionsupporting

confidence: 64%

Section: Introductionmentioning

confidence: 99%

Differences between adult and pediatric onset Henoch‐Schonlein purpura from North India

et al. 2017

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“…Some studies have adopted the former, while others have utilized the European; Except for arthritis/ arthralgia sensitivity analyses have shown no evidence of heterogeneity observed between both. In fact, all patients with HSP complained of purpura without thrombocytopenia [28]. But while palpable purpura was found in 100% of the cases according to the ACR criteria, the EULAR criteria base a diagnosis of HSP on other symptoms [29].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors Associated with Renal Involvement in Childhood Henoch-Schönlein Purpura: A Meta-Analysis

et al. 2016

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Background and objectiveHenoch-Schönlein purpura (HSP) is an important cause of chronic kidney disease in children. This meta-analysis identified risk factors associated with renal involvement in childhood HSP.MethodsPubMed, Embase, and Web of Science were searched. The quality of all eligible studies was assessed using the Newcastle-Ottawa scale criteria. An analysis of possible risk factors was conducted to report the odds ratio (OR) and weighted mean difference (WMD).ResultsThirteen studies (2398 children) revealed 20 possible and 13 significant risk factors associated with renal involvement in HSP, with the following meta-analysis estimates of OR and WMD, with 95% confidence intervals: older age (0.90, 0.61–1.19); age > 10 y (3.13, 1.39–7.07); male gender (1.36, 1.07–1.74); abdominal pain (1.94,1.24–3.04); gastrointestinal bleeding (1.86, 1.30–2.65); severe bowel angina (3.38, 1.17–9.80); persistent purpura (4.02, 1.22–13.25); relapse (4.70, 2.42–9.14); WBC > 15 × 109/L (2.42, 1.39–4.22); platelets > 500 × 109/L (2.98, 1.22–7.25); elevated antistreptolysin O (ASO) (2.17, 1.29–3.64); and decreased complement component 3 (C3) (3.13, 1.62–6.05). Factors not significantly associated with renal involvement were: blood pressure; orchitis; elevated C-reactive protein; elevated erythrocyte sedimentation rate (ESR); and elevated serum IgA/IgE or IgG. Arthritis/arthralgia may be a risk factor according to the criteria of the American College of Rheumatology (1.41, 1.01–1.96).ConclusionThe following are associated with renal involvement in pediatric HSP: male gender; > 10 y old; severe gastrointestinal symptoms (abdominal pain, gastrointestinal bleeding, and severe bowel angina); arthritis/arthralgia; persistent purpura or relapse; WBC > 15 × 109/L; platelets > 500 × 109/L; elevated ASO; and low C3. Relevant clinical interventions for these risk factors may exert positive effects on the prevention of kidney disease during the early stages of HSP. However, the results should be interpreted cautiously due to the limitations of the studies.

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“…10 Studi sebelumnya juga melaporkan hasil serupa. 7,15 Semua pasien mendapatkan terapi kortikosteroid, yaitu metilprednisolon dan prednison. Kortikosteroid berfungsi menghambat proliferasi sel T, T-cell dependent immunity, dan transkripsi gen sitokin (IL-1,IL-2,IL-6, interferon gamma, TNF-α).…”

Section: Pembahasanunclassified

“…6 Penelitian di Indonesia didapatkan hasil lebih tinggi untuk usia 11-15 tahun dengan rasio Odds 3,1, dengan menganalisis usia saat onset sebagai faktor prediktor nefritis pada anak PHS. 7 Tujuan penelitian ini adalah untuk menentukan usia ≥10 tahun, purpura persisten, gejala abdomen berat dan relaps sebagai faktor prediktor nefritis pada anak dengan PHS. …”

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Faktor Prediktor Nefritis pada Anak dengan Purpura Henoch-Schonlein

Wardhana¹,

Satria

Hapsara

2017

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Latar belakang. Penyakit purpura Henoch-Schonlein (PHS) dapat menyebabkan komplikasi nefritis. Nefritis PHS dapat membaik sendiri atau berkembang menjadi penyakit ginjal kronik. Beberapa faktor prediktor telah diketahui berhubungan dengan kejadian nefritis PHS. Tujuan. Menentukan usia ≥10 tahun, purpura persisten, gejala abdomen berat dan relaps sebagai faktor prediktor nefritis pada PHS. Metode. Dilakukan studi kohort retrospektif. Sampel penelitian adalah anak berusia 1 tahun -18 tahun dengan PHS yang dirawat di Instalasi Kesehatan Anak RSUP Dr. Sardjito Yogyakarta periode Januari 2008-Agustus 2016 yang memenuhi kriteria inklusi. Sampel diambil secara konsekutif, kemudian diidentifikasi adanya faktor prediktor nefritis berdasarkan data rekam medis. Analisis bivariat untuk menghitung nilai p serta analisis multivariat dengan regresi logistik. Hasil. Diikutsertakan 80 pasien yang yang diikuti selama 6 bulan. Didapatkan nefritis pada 31 pasien (38,75%). Analisis bivariat dan multivariat menunjukkan bahwa hanya gejala abdomen berat yang merupakan faktor prediktor nefritis dengan nilai p=0,027 dan p=0,021, dan RR 3,759 (IK95%: 1,222-11,562). Kesimpulan. Gejala abdomen berat merupakan faktor prediktor pada kejadian nefritis PHS dan meningkatkan risiko 3,75 kali terjadinya nefritis PHS. Usia ≥10 tahun, purpura persisten, dan relaps tidak terbukti berpengaruh pada kejadian nefritis PHS. Sari Pediatri 2016;18(3):209-13Kata kunci: purpura Henoch-Schonlein, faktor prediktor, nefritis, gejala abdomen berat, purpura persiste Nephritis Predictive Factors in Children with Henoch-Schonlein PurpuraAhmad Wisnu Wardhana, Cahya Dewi Satria, Sunartini Background. Nephritis could be a complication of Henoch-Schonlein purpura (HSP). Henoch-schonlein purpura nephritis (HSPN) could be self limited or develop to chronic kidney disease. Some predictive factor for nephritis Henoch-Schonlein purpura has been identified . Objective. To determine age ≥ 10 years, persistent purpura, severe abdominal symptom and relaps are predictive factors for HSPN. Methods. A retrospective study was performed. Samples were children aged 1 years -18 years with HSP who came to the Pediatric Department of Dr. Sardjito hospital during January 2008-August 2016 and met the inclusion criteria. Samples were taken consecutively. We looked for the presence of predictive factors for HSP based on medical records. Bivariate analysis using chi-square test to calculate p value and multivariate analysis with logistic regression were conducted. Results. A total of 80 patients were included in the study. Their followed during six month after onset. There were 31 patients (38,75%) with nephritis. Bivariate and multivariate analysis showed that only severe abdominal symptom as a predictive factors for nephritis. (p value= 0,027 and p value=0,021, RR 3,759 95% CI 1,562). Conclusion. Severe abdominal symptom as a predictive factors for HSPN and it increase risk 3,7 times develop HSPN. Age ≥ 10 years at onset, persistent purpura and relapse were not affect HSPN. Sari Pediatri 20...

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Age of onset as a risk factor of renal involvement in Henoch-Schönlein purpura

Cited by 52 publications

References 10 publications

Differences between adult and pediatric onset Henoch‐Schonlein purpura from North India

Differences between adult and pediatric onset Henoch‐Schonlein purpura from North India

Risk Factors Associated with Renal Involvement in Childhood Henoch-Schönlein Purpura: A Meta-Analysis

Faktor Prediktor Nefritis pada Anak dengan Purpura Henoch-Schonlein

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