Renal Involvement in Children with Henoch-Schönlein Purpura

Abstract

Objective:Henoch-Schönlein purpura (HSP) is the most common systemic vasculitis in childhood. In this study, we aimed to retrospectively analyze the clinical and laboratory findings and treatment results in terms of renal involvement features in pediatric patients diagnosed with HSP who were hospitalized or applied to our outpatient clinic.Method:This study included 50 patients who were diagnosed with HSP, admitted to the University of Health Sciences Turkey, İstanbul Bağcılar Training and Research Hospital Pediatrics Clinic between 2012 and 2015, and followed up regularly for at least 9 months.Results:The patients included in the study were between the ages of 3 and 16 years (mean age 6.9 years). Thirty-one patients with kidney involvement were between the ages of 5 and 16 years (mean age 10.1 years). 30% of the cases were female (n=15) and 70% were male (n=35). Of the patients with kidney involvement, 11 (35%) were female and 20 (65%) were male. The disease was more common in males, consistent with the literature (p<0.05). The season in which the disease occurred was determined as winter in 10 cases (20%), spring in 11 cases (22%), summer in 10 cases (20%), and autumn in 19 cases (38%). Skin involvement was found in the form of petechiae purpura in all cases (100%), gastrointestinal involvement in 29 patients (58%), joint involvement in 21 patients (42%), kidney involvement in 31 patients (62%), and neurological involvement in 1 (2%) patient. During the follow-up, recurrence was detected in 13 (26%) of the patients. Renal findings developed in 64.6% of the patients within the first 4 weeks and in 35.4% of the patients in the later period. Hematuria was found in all 31 patients with renal involvement, proteinuria in 5 (10%) patients, massive proteinuria in 2 (4%) patients, urea and creatinine elevation in 2 (4%) patients, and high blood pressure in 4 (8%) patients. Renal involvement was found in 23 (79%) of 29 patients with gastrointestinal involvement. Renal involvement was detected in 8 (38%) of the remaining 21 patients. These results were significant in terms of gastrointestinal involvement and renal involvement (p<0.05).Conclusion:The most common finding of HSP after purpuric rash is renal involvement, and renal involvement may develop with hematuria, proteinuria, nephrotic syndrome, hypertension, and acute kidney failure. It was determined that renal involvement occurred especially in the first 4 weeks, and the probability of renal involvement increased in patients with gastrointestinal involvement. Considering the wide spectrum of renal involvement in patients with HSP, it was emphasized that the importance of follow-up and monitoring for possible serious renal disease in proteinuria and hypertensive patients, together with angiotensin receptor blocker treatment, as in IgA nephropathy, can yield extremely positive results.

Keywords

• children
• henoch-schönlein purpura
• renal involvement