Pediatrics & Neonatology
Volume 50, Issue 4 , Pages 162-168, August 2009

Clinical Manifestations and Outcomes of Henoch-Schönlein Purpura: Comparison between Adults and Children

  • Shih-Pin Hung

      Affiliations

    • Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
    • Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan
    • ,
  • Yao-Hsu Yang

      Affiliations

    • Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
    • ,
  • Yu-Tsan Lin

      Affiliations

    • Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
    • ,
  • Li-Chieh Wang

      Affiliations

    • Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
    • ,
  • Jyh-Hong Lee

      Affiliations

    • Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
    • ,
  • Bor-Luen Chiang

      Affiliations

    • Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
    • Corresponding Author InformationCorresponding author. Department of Pediatrics, National Taiwan University Hospital, Fl. 7, No. 7, Chung-San South Road, Taipei 100, Taiwan, Republic of China

Received 17 July 2006; received in revised form 4 January 2009; accepted 16 January 2009.

Article Outline

Background

Henoch-Schönlein purpura (HSP) primarily affects children, but age at onset is thought to be important in determining disease severity and outcome. This study compared the clinical and laboratory data from children and adults with HSP.

Methods

This retrospective 5-year study enrolled 65 children and 22 adult HSP patients attending a medical center.

Results

Gross hematuria and lower-extremity edema were significantly more frequent in adults (p < 0.05). All the children developed renal involvement within 2 weeks, while 67% of the adult patients developed hematuria by the fifth week of disease onset. Elevated white blood cell count and increased erythrocyte sedimentation rate were significantly more common in children (p < 0.05). Adults had a higher frequency of renal involvement (p < 0.05), though this was also present in 14 children (21.54%), 12 with isolated hematuria and proteinuria and two with nephrotic syndrome. All the children maintained normal renal function. Twelve adults had renal involvement (52.6%), six with progression to renal insufficiency. Patients with abdominal pain at disease onset had a significantly higher probability of developing nephrotic syndrome (p < 0.05). Logistic regression revealed that age > 20 years, male, bloody stools, clinical course with relapse of purpuric rash, and persistent rash for > 1 month were poor prognostic indicators for HSP nephritis (p < 0.05).

Conclusions

HSP nephritis in adults had a higher risk of progression to renal insufficiency. More aggressive treatment and extended follow-up with repeated urinalysis for at least 6 weeks were often necessary, especially in older patients.

Key Words:  adult , children , Henoch-Schönlein purpura , nephrotic syndrome , nephritis

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References 

  1. Narchi H . Risk of long term renal impairment and duration of follow up recommended for Henoch-Schonlein purpura with normal or minimal urinary findings: a systematic review . Arch Dis Child . 2005;90:916–920
  2. Fervenza FC . Update from medicine: Henoch-Schönlein purpura nephritis . Intern J Dermatol . 2003;42:170–177
  3. Saulsburry FT . Henoch-Schönlein purpura . Curr Opin Rheumatol . 2001;13:35–40
  4. Rostoker G . Schonlein-Henoch purpura in children and adults: diagnosis, pathophysiology and management . Biodrugs . 2001;15:99–138
  5. Yang YH , Hung CF , Hsu CR , et al.   A nationwide survey on epidemiological characteristics of childhood Henoch-Schönlein purpura in Taiwan . Rheumatology . 2005;44:618–622
  6. Crowson AN , Mihm MC , Magro CM . Cutaneous vasculitis: a review . J Cutan Pathol . 2003;30:161–173
  7. García-Porrúa C , Calvino MC , Liorca J , Couselo JM , González-Gay MA . Henoch-Schönlein purpura in children and adults: clinical differences in a defined population . Semin Arthritis Rheum . 2002;32:149–156
  8. 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;13:1271–1278
  9. Mills JA , Michel BA , Bloch DA , et al.   The American College of Rheumatology 1990 criteria for the classification of Henoch-Schönlein purpura . Arthritis Rheum . 1990;33:1114–1121
  10. Saulsbury FT . Henoch-Schönlein purpura in children report of 100 patients and review of the literature . Medicine (Baltimore) . 1999;78:395–409
  11. Coppo R , Mazzucco G , Cagnoli L , Lupo A , Schena FP . Long-term prognosis of Henoch-Schönlein nephritis in adults and children. Italian Group of Renal Immunopathology Collaborative Study on Henoch-Schönlein purpura . Nephrol Dial Transplant . 1997;12:2277–2283
  12. Allen DM , Diamond LK , Howell DA . Anaphylactoid purpura in children (Schonlein-Henoch syndrome): review with a follow-up of the renal complications . AMA J Dis Child . 1960;99:833–854
  13. Lin SJ , Huang JL . Henoch-Schönlein purpura in Chinese children and adults . Asian Pac J Allergy Immunol . 1998;16:21–25
  14. Rieu P , Noël LH . Henoch-Schönlein nephritis in children and adults. Morphological features and clinicopathological correlations . Ann Med Intern (Paris) . 1999;150:151–159
  15. Goldstein AR , White RH , Akuse R , Chantler C . Long-term follow-up of childhood Henoch-Schönlein nephritis . Lancet . 1992;339:280–282
  16. White RH . Henoch-Schönlein nephritis. A disease with significant late sequelae . Nephron . 1994;68:1–9
  17. Kawasaki Y , Suzuki J , Sakai N . Clinical and pathological features of children with Henoch-Schönlein purpura nephritis: risk factors associated with poor prognosis . Clin Nephrol . 2003;60:153–160
  18. Kobayashi O , Wada H , Okawa K , Takeyama I . Schoenlein-Henoch's syndrome in children . Contrib Nephrol . 1997;4:48–71
  19. Rigante D , Candelli M , Federico G , Bartolozzi F , Porri MG , Stabile A . Predictive factors of renal involvement or relapsing disease in children with Henoch-Schönlein purpura . Rheumatol Int . 2005;25:45–48
  20. Kaku Y , Nohara K , Honda S . Renal involvement in Henoch-Schönlein purpura: a multivariate analysis of prognostic factors . Kidney Int . 1998;53:1755–1759
  21. García-Porrúa C , González-Louzao C , Liorca J , González-Gay MA . Predictive factors for renal sequelae in adults with Henoch-Schönlein purpura . J Rheumatol . 2001;28:1019–1024
  22. Kraft DM , McKee D , Scott C . Henoch-Schönlein purpura: a review . Am Fam Physician . 1998;58:405–408 411.
  23. Habbib R , Niaudet R , Levy M . Schoenlein-Henoch purpura nephritis and IgA nephropathy . In:  Tisher CC ,  Brenner BM editor. Renal Pathology with Clinical and Functional Correlations . 2nd ed. Philadelphia: Lippincott; 1989;p. 427–523
  24. Watanabe T , Takahashi S , Nakajo S , Hamasaki M . Pathological improvement of IgA nephropathy and Henoch-Schoenlein purpura nephritis with urokinase therapy . Acta Paediatr Jpn . 1996;38:622–628
  25. Oner A , Tinaztepe K , Erdogan O . The effect of triple therapy on rapidly progressive type of Henoch-Schoenlein nephritis . Pediatr Nephrol . 1995;9:6–10
  26. García-Porrúa C , González-Gay MA . Comparative clinical and epidemiology study of hypersensitivity vasculitis versus Henoch-Schönlein purpura in adults . Semin Arthritis Rheum . 1999;28:404–412
  27. Calviño MC , Llorca J , García-Porrúa C , Fernández-Iglesias JL , Rodriguez-Ledo P , González-Gay MA . Henoch-Schönlein purpura in children from northwest Spain: a 20-year epidemiologic and clinical study . Medicine (Baltimore) . 2001;80:279–290

PII: S1875-9572(09)60056-5

doi:10.1016/S1875-9572(09)60056-5

Pediatrics & Neonatology
Volume 50, Issue 4 , Pages 162-168, August 2009

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