Time of Onset and Risk Factors of Renal Involvement in Children with Henoch-Schönlein Purpura: Retrospective Study

Abstract

Background: Henoch-Schönlein purpura (HSP) is a common systemic vasculitis in children, involving the skin, musculoskeletal system, gastrointestinal tract and kidneys. Some studies in children have shown possible risk factors linked with the development and severity of HSP Nephritis (HSPN). The aim of this study was to research predicting factors for the development of HSPN. Methods: We retrospectively evaluated 132 pediatric patients with HSP, according to EULAR/PRINTO/PRESS criteria. All patients were screened for HSPN by urinalysis. Finally, we compared demographic, clinical and laboratory data in HSP patients with and without nephritis. Results: The median age at HSP diagnosis [6.2 (2.6–17.5) vs. 5.5 (0.8–15.4) years, p = 0.03] and the incidence of abdominal pain (48 vs. 27%, p = 0.01) were significantly higher in HSPN patients. No differences were evidenced regarding gender, allergic diseases, skin recurrences, gastrointestinal involvement, musculoskeletal involvement, scrotal involvement, and laboratory data (white blood cell count, neutrophil count, lymphocyte count, platelet count, C-reactive protein, erythrocyte sedimentation rate, and blood concentration of IgA). Conclusions: The age at diagnosis and abdominal pain were independent risk factors for renal involvement in HSP patients. However, due to the retrospective nature of this study, further long-term and prospective studies will be necessary.

Análise da incidência e fatores predisponentes para recorrência da Púrpura de Henoch-Schönlein em pacientes pediátricos

“…Embora a PHS seja geralmente considerada uma patologia autolimitada, também pode ser fatal caso a inflamação sistêmica persista, ou caso vários órgãos estejam envolvidos. Em pacientes com síndrome nefrítica, mais especificamente a Doença de Berger (Nefropatia por IgA), ocorre depósitos da imunoglobulina no mesângio, estrutura glomerular responsável por sua estruturação, o que leva à hematúria (Carucci et al, 2022).…”

“…Estudos demonstram que cerca de 40% dos casos de PHS infantil possuem envolvimento renal, com maior prevalência em pacientes do sexo masculino maiores de 10 anos. Laboratorialmente, os achados de leucocitose, trombocitose, altos níveis de antiestreptolisina O (ASLO), queda do complemento (C3) e proteinúria são preditivos para doença renal terminal (Gómez et al, 2019;Carucci et al, 2022).…”

“…Já no estudo proposto porCarucci et al (2022), 132 pacientes pediátricos com PHS foram avaliados, sendo separados em grupos com e sem nefrite, por meio de exame de urina. Foi observado que a idade maior e a incidência de dor abdominale-Acadêmica, v. 3, n. 3, e3233311, 2022 (CC BY 4.0) | ISSN 2675-8539 | DOI: http://dx.doi.org/10.52076/eacad-v3i3.311…”

Analysis of Prognostic Factors on the Regular Glucocorticoid Combined with Cyclophosphamide Pulse in Children Suffered from Henoch-Schönlein Purpura Nephritis with Nephrotic Proteinuria

“…Other studies noted that rash recurrence ≥ 3 times, rash duration time ≥ 1 month were risk factors for pediatric HSPN [33,34]; purpura relapses more than four times predicted a poor prognosis of HSPN [35]. Repeated rashes in the setting of HSPN may indicate increased in ammation/neutrophilia and vasculitis.…”

Immunoglobulin A vasculitis nephritis: Current understanding of pathogenesis and treatment

“…According to the European SHARE (Single Hub and Access point for paediatric Rheumatology in Europe) plane[ 6 ] , all IgAV patients should be investigated for renal involvement at diagnosis and throughout follow-up by measuring blood pressure, determining the presence of haematuria, quantifying albuminuria and/or proteinuria and, finally, estimating glomerular filtration rate (eGFR)[ 7 ]. If initial tests are normal, they need to be monitored for at least 6-12 mo[ 8 - 12 ]. The renal biopsy should be performed in the case of impaired eGFR, persistent proteinuria, nephrotic ( e.g.…”