Renal involvement in Henoch-Schönlein purpura: a multivariate analysis of initial prognostic factors

Abstract

ResumoObjetivos: Identificar fatores preditivos iniciais de envolvimento renal nas crianças e adolescentes com púrpura de Henoch-Schönlein.Métodos: Por um período de 21 anos, os prontuários de 142 pacientes com diagnóstico de púrpura de Henoch-Schönlein admitidos em nosso Hospital Universitário foram revistos. Os fatores preditivos iniciais avaliados nos primeiros 3 meses incluíram: dados demográficos, manifestações clínicas (púrpura palpável persistente, artrite, dor abdominal, dor abdominal intensa, sangramento gastrointestinal, orquite, envolvimento do sistema nervoso central e hemorragia pulmonar), exames laboratoriais (níveis séricos de IgA) e tratamento utilizado (corticosteróides, imunoglobulina endovenosa e medicação imunossupressora). Os pacientes foram divididos em dois grupos (com presença ou ausência de nefrite) e avaliados de acordo com a análise univariada e multivariada.Resultados: Nefrite foi evidenciada em 70 pacientes (49,3%). A análise univariada revelou que dor abdominal intensa (p = 0,0049; OR = 1,6; IC95% 1,18-2,21), sangramento gastrointestinal (p = 0,004; OR = 1,6; IC95% 1,10-2,26) e uso dos corticosteróides (p = 0,0012; OR = 1,7; IC95% 1,28-2,40) foram associados com uma maior incidência de envolvimento renal. Na análise multivariada, a regressão logística mostrou que a única variável independente na predição da ocorrência de nefrite foi dor abdominal intensa (p < 0,012; OR = 2,593; IC95% 1,234-5,452). Conclusões Results: Evidence of nephritis was detected in 70 patients (49.3%).The univariate analysis revealed that severe abdominal pain (p = 0.0049; OR = 1.6; 95%CI 1.18-2.21), gastrointestinal bleeding (p = 0.004; OR = 1.6; 95%CI 1.10-2.26) and corticosteroid use (p = 0.0012; OR = 1.7; 95%CI 1.28-2.40) were all associated with increased incidence of renal involvement. In the multivariate analysis, logistic regression demonstrated that the only independent variable that predicted nephritis was intense abdominal pain (p < 0.012; OR = 2.593; 95%CI 1.234-5.452). Conclusions:Severe abdominal pain was a significant predictor of nephritis in Henoch-Schönlein purpura. Consequently, pediatric patients exhibiting this clinical manifestation should be rigorously monitored, due to the increased risk of renal involvement. J Pediatr (Rio J). 2007;83(3):259-266:Henoch-Schönlein purpura, nephritis, children, kidney disease, prognosis.

Henoch-Schönlein purpura presenting with multiplex gastrointestinal manifestations and massive nephrotic syndrome in adulthood — a case report

“…On the basis of previous reports, it remains unclear whether severe abdominal pain, persistent purpura, or corticosteroid treatment is associated with the development of HSP nephritis. Multivariate analysis performed by de Almeida et al found severe abdominal pain to be the only independent variable predicting to HSP nephritis, while their univariate analysis indicated that all of these are associated with renal improvement [8]. In our case, renal manifestation occurred before corticosteroid initiation, and it was accompanied by severe abdominal pain and gastrointestinal bleeding.…”

Faktor Prediktor Nefritis pada Anak dengan Purpura Henoch-Schonlein

“…Hasil serupa juga didapatkan pada analisis bivariat sebelumnya. 24 Analisis multivariat mendapatkan hasil bermakna pada gejala abdomen berat terhadap kejadian nefritis. Gejala abdomen berat juga meningkatkan risiko terjadinya nefritis 3,7 kali dibanding tanpa gejala abdomen berat.…”

Association study between matrix metalloproteinase-9 gene (MMP9) polymorphisms and the risk of Henoch-Schönlein purpura in children

“…Additional features including arthritis and abdominal pain were accepted as being consistent with the diagnosis (Kawasaki et al, 2003;Reamy et al, 2009). HSPN was defined by abnormal urinalysis results in HSP patients and categorized as follows: normal levels of proteinuria (proteinuria <0.5 g/L and hematuria ≥5 red blood cells per high-power microscopic field); low-grade proteinuria (<1 g/L and/or hematuria ≥5 red blood cells per highpower microscopic field); and heavy proteinuria (≥1 g/L and/or hematuria ≥5 red blood cells per high-power microscopic field) (Hung et al, 2006;de Almeida et al, 2007). The control group included 204 unrelated healthy people (mean age 6.75 ± 2.36 years) recruited from the medical examination center of our hospital.…”