Clinical Aspect and Outcome of Henoch-Schoenlein Purpura in Children in Relation to Renal Biopsy Pathologic Findings
Abstract
The most common childhood vasculitis is Henoch Schoenlein Purpura (HSP). It occurs at any age peaking at around 4-6 years. The classic manifestations of HSP are skin rash, along with any from a triad of other organ system involvement, including gastrointestinal, musculoskeletal, and renal systems. Renal involvement is much more common in children than in adults. 255 HSP patients attending our tertiary referral hospital enrolled in this 10-year retrospective study from 2009 to 2019. According to our study, HSP was more common in males. Most of the patients were between 1-16 years (mean 7.04 years) old. Of these patients, only 19.22% had proteinuria, 17.25% had increased creatinine, 61.7% of patients had hematuria, 67.06 had a fever, and 69.8% had abdominal pain. 24.31% of them had bloody diarrhea. Skin and joint involvement were recorded in 44.7% and 74.9% of patients, respectively. Children affected by HSP may present with different clinical manifestations. We assessed these clinical presentations and outcomes of patients and compared them with renal pathology findings to reveal any prognostic significance of renal pathologic findings in HSP patients.
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2. Gardner-Medwin JM, Dolezalova P, Cummins C, Southwood TR. Incidence of henoch-schonlein purpura, kawasaki disease, and rare vasculitides in children of different ethnic origins. Lancet 2002;360:1197-202.
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5. Yang YH, Hung CF, Hsu CR, Wang LC, Chuang YH, Lin YT, Chiang BL. A nationwide survey on epidemiological characteristics of childhood Henoch Schönlein purpura in Taiwan. Rheumatology 2005;44:618-22.
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7. Nong BR, Huang YF, Chuang CM, Liu CC, Hsieh KS. Fifteen-year experience of children with Henoch-Schonlein purpura in southern Taiwan, 1991–2005, J Microbiol Immunol Infect 2007;40:371-6.
8. Eleftheriou D, Brogan PA. Vasculitis in children. Best Pract Res Clin Rheumatol 2009;23:309-23.
9. Jauhola O, Ronkainen J, Koskimies O, Ala-Houhala M, Arikoski P, Holtta, T, et al. Clinical course of extrarenal symptoms in Henoch-Schonlein, purpura: a 6-month prospective study. Arch Dis Child 2010;95:871-6.
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11. Oni L, Sampath S. Childhood IgA Vasculitis (Henoch Schonlein Purpura)—Advances and Knowledge Gaps. Front Pediatr 2019;7:257.
12. Huang X, Wu X, Le W, Hao Y, Wu J, Zeng C, et al. Renal prognosis and related risk factors for henoch-schonlein purpura nephritis: a chinese adult patient cohort. Sci Rep 2018;8:5585.
13. Uehara E, Nagata C, Masuda H, Fujimori K, Kobayashi S, Kubota M, et al. Risk factors of long hospital stay for immunoglobulin a vasculitis: single-center study. Pediatr Int 2018;60:918-22.
14. Lim Y, Yi BH, Lee HK, Hong HS, Lee MH, Choi SY, et al. Henoch-Schonlein purpura: ultrasonography of scrotal and penile involvement. Ultrasonography 2015;34:144-7.
15. Garzoni L, Vanoni F, Rizzi M, Simonetti GD, Goeggel Simonetti B, Ramelli GP, et al. Nervous system dysfunction in Henoch-Schonlein syndrome: systematic review of the literature. Rheumatology (Oxford) 2009;48:1524-9.
16. Moradinejad M, Ziaee V, Marashi SM, Nasri nasrabadi Z. Survey of clinical manifestations in Henoch Schönlein purpura in follow up. Med J Mashhad Univ Med Sci 2014;57:829-34.
17. He X, Yu C, Zhao P, Ding Y, Liang X, Zhao Y, et al. The genetics of Henoch- Schonlein purpura: a systematic review and meta-analysis. Rheumatol Int 2013;33:1387-95.
18. Hung SP, Yang YH, Lin YT, Wang LC, Lee JH, Chiang BH. Clinical Manifestations and Outcomes of Henoch-Schönlein Purpura: Comparison between Adults and Children. Pediatr Neonatol 2009;50:162-8.
19. Karambin MM, Hashemian H. Childhood Arthritis: Rate of Different Types. Acta Med Iran 2009; 47:31-4.
20. Fervenza FC. Update from medicine: Henoch-Schönlein purpura nephritis. Intern J Dermatol 2003;42:170-7.
21. Pillebout E, Thervet E, Hill G, Alberti C, Vanhille P, Nochy D. Henoch-Schönlein purpura in adults: outcome and prognostic factors. J Am Soc Nephrol 2002;13:1271-8.
22. Nickavar A, Ehsanipour F. Recurrent Henoch-Schonlein Purpura in Familial Mediterranean Fever. Acta Med Iran 2008;46:349-52.
23. Zhang GZ, Wu XC, Yi H, Peng XJ, Dang XQ, He XJ, et al. Relationship between clinical manifestations and renal pathology in children with Henoch-Schonlein purpura nephritis. Zhongguo Dang Dai Er Ke Za Zhi 2007;9:129-32
24. Karambin MM, Hashemian H. Childhood Arthritis: Rate of Different Types, Acta Med Iran 2009;47: 31-4.
2. Gardner-Medwin JM, Dolezalova P, Cummins C, Southwood TR. Incidence of henoch-schonlein purpura, kawasaki disease, and rare vasculitides in children of different ethnic origins. Lancet 2002;360:1197-202.
3. Yoon Kang, Jin-su Park, You-Jung Ha, Mi-il Kang, Hee-Jin Park, Sang-Won Lee, at al, Differences in Clinical Manifestations and Outcomes between Adult and Child Patients with Henoch-Schönlein Purpura. J Korean Med Sci 2014;29:198-203.
4. Crowson AN, Mihm MC, Magro CM. Cutaneous vasculitis a review. J Cutan Pathol 2003;30:161-73.
5. Yang YH, Hung CF, Hsu CR, Wang LC, Chuang YH, Lin YT, Chiang BL. A nationwide survey on epidemiological characteristics of childhood Henoch Schönlein purpura in Taiwan. Rheumatology 2005;44:618-22.
6. Gupta V, Aggarwal A, Gupta R, Chandra Chowdhury A, Agarwal V, Lawrence A, et al. Differences between adult and pediatric onset Henoch- Schonlein purpura from North India. Int J Rheum Dis 2018;21:292-8.
7. Nong BR, Huang YF, Chuang CM, Liu CC, Hsieh KS. Fifteen-year experience of children with Henoch-Schonlein purpura in southern Taiwan, 1991–2005, J Microbiol Immunol Infect 2007;40:371-6.
8. Eleftheriou D, Brogan PA. Vasculitis in children. Best Pract Res Clin Rheumatol 2009;23:309-23.
9. Jauhola O, Ronkainen J, Koskimies O, Ala-Houhala M, Arikoski P, Holtta, T, et al. Clinical course of extrarenal symptoms in Henoch-Schonlein, purpura: a 6-month prospective study. Arch Dis Child 2010;95:871-6.
10. Trapani S, Micheli A, Grisolia F, Resti M, Chiappini E, Falcini F, et al. Henoch Schonlein purpura in childhood: epidemiological and clinical analysis of 150 cases over a 5-year period and review of literature. Semin Arthrit Rheum 2005;35:143-53.
11. Oni L, Sampath S. Childhood IgA Vasculitis (Henoch Schonlein Purpura)—Advances and Knowledge Gaps. Front Pediatr 2019;7:257.
12. Huang X, Wu X, Le W, Hao Y, Wu J, Zeng C, et al. Renal prognosis and related risk factors for henoch-schonlein purpura nephritis: a chinese adult patient cohort. Sci Rep 2018;8:5585.
13. Uehara E, Nagata C, Masuda H, Fujimori K, Kobayashi S, Kubota M, et al. Risk factors of long hospital stay for immunoglobulin a vasculitis: single-center study. Pediatr Int 2018;60:918-22.
14. Lim Y, Yi BH, Lee HK, Hong HS, Lee MH, Choi SY, et al. Henoch-Schonlein purpura: ultrasonography of scrotal and penile involvement. Ultrasonography 2015;34:144-7.
15. Garzoni L, Vanoni F, Rizzi M, Simonetti GD, Goeggel Simonetti B, Ramelli GP, et al. Nervous system dysfunction in Henoch-Schonlein syndrome: systematic review of the literature. Rheumatology (Oxford) 2009;48:1524-9.
16. Moradinejad M, Ziaee V, Marashi SM, Nasri nasrabadi Z. Survey of clinical manifestations in Henoch Schönlein purpura in follow up. Med J Mashhad Univ Med Sci 2014;57:829-34.
17. He X, Yu C, Zhao P, Ding Y, Liang X, Zhao Y, et al. The genetics of Henoch- Schonlein purpura: a systematic review and meta-analysis. Rheumatol Int 2013;33:1387-95.
18. Hung SP, Yang YH, Lin YT, Wang LC, Lee JH, Chiang BH. Clinical Manifestations and Outcomes of Henoch-Schönlein Purpura: Comparison between Adults and Children. Pediatr Neonatol 2009;50:162-8.
19. Karambin MM, Hashemian H. Childhood Arthritis: Rate of Different Types. Acta Med Iran 2009; 47:31-4.
20. Fervenza FC. Update from medicine: Henoch-Schönlein purpura nephritis. Intern J Dermatol 2003;42:170-7.
21. Pillebout E, Thervet E, Hill G, Alberti C, Vanhille P, Nochy D. Henoch-Schönlein purpura in adults: outcome and prognostic factors. J Am Soc Nephrol 2002;13:1271-8.
22. Nickavar A, Ehsanipour F. Recurrent Henoch-Schonlein Purpura in Familial Mediterranean Fever. Acta Med Iran 2008;46:349-52.
23. Zhang GZ, Wu XC, Yi H, Peng XJ, Dang XQ, He XJ, et al. Relationship between clinical manifestations and renal pathology in children with Henoch-Schonlein purpura nephritis. Zhongguo Dang Dai Er Ke Za Zhi 2007;9:129-32
24. Karambin MM, Hashemian H. Childhood Arthritis: Rate of Different Types, Acta Med Iran 2009;47: 31-4.
| Files | ||
| Issue | Vol 60 No 12 (2022) | |
| Section | Articles | |
| DOI | https://doi.org/10.18502/acta.v60i12.11830 | |
| Keywords | ||
| Henoch schoenlein purpura Ig A vasculitis Kidney biopsy Leukocytoclastic vasculitis Purpura Renal vasculitis non-Thrombocytopenic systemic vasculitis | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Bazargani B, Rajabi Z, Moghtaderi M. Clinical Aspect and Outcome of Henoch-Schoenlein Purpura in Children in Relation to Renal Biopsy Pathologic Findings. Acta Med Iran. 2023;60(12):772-776.
