Renal manifestations of Henoch-Schonlein purpura in a 6-month prospective study of 223 children

Abstract

Objective To assess the risk factors for developing Henoch-Schönlein purpura nephritis (HSN) and to determine the time period when renal involvement is unlikely after the initial disease onset. Design A prospective study of 223 paediatric patients to examine renal manifestations of Henoch-Schönlein purpura (HSP). The patient's condition was monitored with fi ve outpatient visits to the research centre and urine dipstick testing at home. Results HSN occurred in 102/223 (46%) patients, consisting of isolated haematuria in 14%, isolated proteinuria in 9%, both haematuria and proteinuria in 56%, nephrotic-range proteinuria in 20% and nephroticnephritic syndrome in 1%. The patients who developed HSN were signifi cantly older than those who did not (8.2±3.8 vs 6.2±3.0 years, p<0.001, CI for the difference 1.1 to 2.9). Nephritis occurred a mean of 14 days after HSP diagnosis, and within 1 month in the majority of cases. The risk of developing HSN after 2 months was 2%. Prednisone prophylaxis did not affect the timing of the appearance of nephritis. The risk factors for developing nephritis were age over 8 years at onset (OR 2.7, p=0.002, CI 1.4 to 5.1), abdominal pain (OR 2.1, p=0.017, CI 1.1 to 3.7) and recurrence of HSP disease (OR 3.1, p=0.002, CI 1.5 to 6.3). Patients with two or three risk factors developed nephritis in 63% and 87% of cases, respectively. Laboratory tests or blood pressure measurement at onset did not predict the occurrence of nephritis. Conclusion The authors recommend weekly home urine dipstick analyses for the fi rst 2 months for patients with HSP. Patients with nephritis should be followed up for more than 6 months as well as the patients with HSP recurrence.

HLA-B35, a common genetic trait, in a familial case of Henoch-Schoenlein purpura and Berger's disease

“…While the kidneys are always involved in BD, approximately 50% of patients develop acute kidney involvement in HSP, varying from asymptomatic microscopic hematuria to severe macroscopic hematuria with proteinuria and even to nephrotic syndrome (Chang et al, 2005;Jauhola et al, 2010). Renal involvement typically occurs in the first three months after onset, more commonly with disease relapse.…”

Vasculitis: do we know more to classify better?

“…Purpura was designated as the necessary criterion since it was present in all children with IgAV (HSP) in the web-based pediatric vasculitis registry of PRINTO [10]. Joint involvement, which is more common in children with IgAV (HSP) than in adults [39], and renal involvement, which determines the longterm prognosis [40], were both considered as new criteria. The age criterion was deleted since it was considered to be redundant.…”

Henoch-Schönlein Purpura Nephritis in Childhood

“…Persistent purpura, severe abdominal symptoms and an older age were confirmed as the most significant risk factors for later nephropathy (Bogdanovic, 2009). A prospective study showed that age over 8 years at onset (OR 2.7), abdominal pain (OR 2.1) and a recurrence of Henoch-Schönlein purpura disease (OR 3.1) were independent risk factors for developing nephritis (Jauhola et al, 2010).…”

“…More than half also have proteinuria, which in one eighth is severe enough to cause nephrotic syndrome (Saulsbury, 2001). From a retrospective study, nephritis occurred in 46% of the Henoch-Schönlein purpura patients, consisting of isolated haematuria in 14%, isolated proteinuria in 9%, both haematuria and proteinuria in 56%, nephrotic-range proteinuria in 20% and nephrotic-nephritic syndrome in 1% (Jauhola et al, 2010). Renal involvement is in most cases mild and self-limited in children.…”

“…Beyond that point frequent routine follow-up is neither cost-effective nor necessary in patients with no urine abnormalities during follow-up. However, the length of follow-up time should be increased at least up to 6 months individually in the case of Henoch-Schönlein purpura recurrence and in those developing nephritis (Jauhola et al, 2010).…”