Clinical Characteristics, Diagnostic Findings and Therapeutic Outcome of Children Suffering Henoch-Schonlein Purpura: A Survey of Iranian Children
Journal of Pediatric Nephrology,
Vol. 7 No. 2 (2019),
31 August 2019
Background and Aim: Despite the spread of Henoch-Schonlein purpura (HSP) in all societies, especially in Asian children, no comprehensive study on HSP has been conducted in Iranian children and most of these reports are limited to disease cases or exclusively to patients with HSP. Therefore, this study was conducted to describe the clinical, diagnostic, and therapeutic approaches in children with HSP in Iran.
Methods: This historical cohort study was performed in all children suffering from HSPN hospitalized at Ali-Asghar Children’s Hospital, Tehran between April 2006 and March 2017. The patients' baseline characteristics including demographics, clinical symptoms and laboratory parameters were all collected from hospital files. The patients were followed up for at least six months of initiating treatment and also for 12 to 120 months after treatment.
Results: Of 100 patients with HSP, 18 (11 boys and 7 girls) had indications for biopsy that were included in the study. The mean age of the participants was 7.72 ± 2.69 years. Nephrotic syndrome was found in 44.4% and nephritic syndrome in 61.1% of the patients. Hematuria was found in 66.7%, proteinuria in 66.7%, and hypertension in 38.9% of the patients. The mean serum creatinine was 1.0 ± 0.6 mg/dl with a mean GFR of 95 ± 5ml/min. Regarding pathological classification, 33.3% had class II and 66.7% had class III. With respect to therapeutic regimen, 61.1% were treated only with steroids while others were treated with a combination of steroids and immunosuppressant drugs. During the follow-up time, all patients were treated successfully with the mentioned regimens. In all treated subjects, proteinuria disappeared in all urine samples. Due to complete improvement in all patients, repeated renal biopsy was not indicated.
Conclusion: Kidney involvement occurs as nephritic syndrome in about two thirds of patients and as nephrotic syndrome in the remaining cases. In the majority of patients, treatment with steroids alone is successful although combined therapy with immunosuppressant drugs is required in the remaining patients. In summary, the therapeutic protocols are associated with a significant long-term recovery (a five-year recovery of 87.5% in our study).
Keywords: Henoch-Schonlein purpura; Nephritis; Nephrotic syndrome; Child.
- Henoch-Schonlein purpura
- Nephrotic syndrome
How to Cite
Gardner-Medwin JM, Dolezalova P, Cummins C, South wood TR. Incidence of Henoch-Schönlein purpura, Kawasaki disease, and rare vasculitis in children of different ethnic origins. Lancet 2002;360:1197-1202.
Calviño MC, Llorca J, García-Porrúa C, Fernández-Iglesias JL, Rodriguez-Ledo P, González-Gay MA. Henoch-Schönlein purpura in children from northwestern Spain: a 20-year epidemiologic and clinical study. Medicine (Baltimore) 2001;80:279-290.
Saulsbury FT. Henoch-Schönlein purpura in children. Report of 100 patients and review of the literature. Medicine (Baltimore) 1999;78:395-409.
Nielsen HE. Epidemiology of Schönlein-Henoch purpura. Acta Paediatr Scand 1988;77:125-131.
Stewart M, Savage JM, Bell B, McCord B. Long term renal prognosis of Henoch-Schönlein purpura in an unselected childhood population. Eur J Pediatr 1988;147:113-115.
Yoshikawa N, Ito H, Yoshiya K, Nakahara C, Yoshiara S, Hasegawa O, et al. Henoch-Schoenlein nephritis and IgA nephropathy in children: a comparison of clinical course. Clin Nephrol 1987;27:233-237.
Counahan R, Winter born MH, White RH, Heaton JM, Meadow SR, Bluett NH, et al. Prognosis of Henoch-Schönlein nephritis in children. Br Med J 1977;2:11-14.
Bunchman TE, Mauer SM, Sibley RK, Vernier RL. Anaphylactoid purpura: characteristics of 16 patients who progressed to renal failure. Pediatr Nephrol 1988;2:393-397.
Saulsbury FT. Epidemiology of Henoch-Schönlein purpura. Cleve Clin J Med 2002;69Suppl 2:SII87-SII89.
Feng D, Huang WY, Hao S, Niu XL, Wang P, Wu Y, Zhu GH. A single-center analysis of Henoch-Schonlein purpura nephritis with nephrotic proteinuria in children. Pediatr Rheumatol Online J 2017 Mar 4;15(1):15. doi: 10.1186/s12969-017-0146-4.
Delbet JD,2, Hogan J, Aoun B, Stoica I, Salomon R, Decramer S, Brocheriou I, Deschênes G, Ulinski T. Clinical outcomes in children with Henoch-Schönlein purpura nephritis without crescents. Pediatr Nephrol 2017 Jul;32(7):1193-1199. doi: 10.1007/s00467-017-3604-9. Epub 2017 Feb 15.
Mizerska-Wasiak M, Małdyk J, Demkow U, Roszkowska-Blaim M, Pańczyk-Tomaszewska M. Treatment Outcomes in Children with Henoch-Schönlein Nephritis. AdvExp Med Biol 2016;912:65-72. doi: 10.1007/5584_2016_231.
Naija O, Bouzaraa J, Goucha-Louzir R, Gargah T. Henoch Schonlein Nephrites in children: clinical features and outcome: about 34 cases. Tunis Med 2013 Dec;91(12):700-4.
Pirojsakul K, Tangnararatchakit K, Chalermsanyakorn P, Tapaneya-Olarn W. Clinical outcome of children with Henoch-Schönlein purpura nephritis. J Med Assoc Thai 2012;95(7):878-83.
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