Renal involvement in Henoch-Schönlein purpura

Anca Lupu 6th year (Bagdasar Alina, Gabor Estera) – Faculty of Medicine

Scientific supervisor: Associate Prof. Carmen Duicu

Introduction

• Henoch Schönlein pupura is the most common vasculitis in children, which mainly affects skin, joint, gastrointestinal tract and kidneys.

• Although it is a self limited disease with a good prognosis, sometimes the renal involvement can complicate the evolution of the patient.

• The extrarenal symptoms typically resolve rapidly without complications, and the long-term prognosis is mainly dependent on the severity of renal involvement.

• Renal involvement represents the main element that influences the prognosis in children with Henoch Schönlein purpura, with impact in the morbidity and mortality of children. In this sense, the primordial attention in these studies should be given in establishing an optimal and individual treatment and in finding the factors that indicate the renal impairment.

Material and methods

• From 2008 to 2013, characteristics and clinical manifestations of Henoch-Schönlein purpura were reviewed from medical records of the Pediatrics Department of the Emergency County Hospital of Târgu-Mures, Romania. The collected information included age, gender, clinical manifestations, relevant auxiliary examination results, renal echography and treatment.

ResultsSex distribution

There were 52 hospitalized children with Henoch-Schönlein purpura from January 1, 2008 to December 31, 2013 consisting in 23 males (44,23%) and 29 females (55,77%).

55.77%

44.23%

% patients

femalesmales

ResultsAge of onset of Henoch Schönlein purpura

2 year-5 year 6 year-9 year 10 year-13 year 14 year-17 year0

2

4

6

8

10

12

14

16

18

2017

20

9

6

ResultsClinical manifestation

Skin Joint Gastrointestinal tract Kidneys0

5

10

15

20

25

30

35

40

45

44

33

1820

ResultsHenoch Schönlein nefritis

Sex distribution

70%

30%

femalesmales

ResultsThe age distribution of the patients with

Henoch Schönlein nefritis

2 year-5 year 6 year-9 year 10 year-13 year 14 year-17 year0

1

2

3

4

5

6

7

8

9

5

9

3 3

ResultsHenoch Schönlein nefritis

Renal manifestation

Microscopic haematuria Proteinuria Haematurie+proteinuria0

4

8

12

16

20

7

5

8

ResultsClinical manifestations associated with

Henoch Schönlein nefritis

abdominal manifesta-tion

skin manifestation joint manifestation isolated0

2

4

6

8

10

12

14

16

8

15

10

3

ResultsTiming of the onset of Henoch Schönlein

nefritis

1 day-1 week 1 week-1 month 1 month-1 year >1 year0

2

4

6

8

10

12

11

2

43

ResultsProlonged nefritis

< 1 month > 1 month > 2 months > 6 months0

1

2

3

4

5

6

7

8

9

9

5

3 3

Results Association between upper respiratory tract

infection and Henoch Schönlein nefritis

55%

45% with URTIwitout URTI

ResultsAssociation between the recurrence of Henoch Schönlein purpura and the developing of Henoch Schönlein nefritis

• A recurrence of Henoch Schönlein purpura disease was considered when a patient who had been asymptomatic for at least 1 month presented with a new skin lesions or other symptoms related to Henoch Schönlein purpura[1].

• There were 16 patients with the recurrence of Henoch Schönlein purpura that developped Henoch Schönlein nefritis.

80%

20%

with the reccurence of HSP

Without the reccurence of HSP

Discussions• Henoch Schönlein nefritis occurred in 20/52 pediatric patients,

consisiting in isolated haematuria (7 cases, representing 35%), isolated mild proteinuria in 5 patients (25%), both haematuria and proteinuria in 8 cases (40%).

• Renal involvement in children with Henoch Schönlein purpura is more common in age group 11 to 15 years old [2], but our study shows the highest incidence in the 6 to 9 years age group.

• Although international studies suggest that upper respiratory tract infection and previous streptococcal infection seemed to associate with the development of Henoch Schönlein nefritis [1], we found no such association.

• The recurrence of Henoch Schönlein purpura disease seemed to associate with the development of Henoch Schönlein nefritis.

Conclusions

• It is absolutely necessary that children who developped Henoch Schönlein nefritis to be monitered by a pediatric nephrologist, as the long term prognosis of Henoch Schönlein purpura disease is directly dependent on the severity of renal involvement.

Bibliography

1) Jauhola O, Ronkainen J, Koskimies O et al - Renal manifestations of Henoch-Schonlein purpura in a 6-month prospective study of 223 children, Arch Dis Child, 2010, 95: 877-882.

2) Ghrahani R, Ledika MA, Sapartini G et al - Age of onset as a risk factor of renal involvement in Henoch-Schönlein purpura, Asia Pac Allergy, 2014, 4: 42-47.