title: Long-term prognosis of Henoch-Schönlein nephritis in adults and children. Italian Group of Renal Immunopathology Collaborative Study on Henoch-Schönlein purpura.
abstract: BACKGROUND
  The aim of this multicentre collaborative study was to compare the progression of renal disease in children and adults with Henoch-Schönlein purpura (HPS) nephritis selected on the basis of IgA-dominant renal deposits and biopsy material available for review.
  
  
  METHODS
  The analysis was performed in 152 patients (95 adults and 57 children < 16 years old at diagnosis) with a follow-up (> or = 1 year up to 20 years (4.9 +/- 3.4 years in adults and 4.8 +/- 3.9 years in children).
  
  
  RESULTS
  Renal histology and clinical presentation were similar in both age groups: crescents were found in 36% of adults and 34.6% of children (in only 2.7% of adults and 1.9% of children involving > 50% of glomeruli), nephrotic-range proteinuria in 29.5% of adults and 28.1% of children and functional impairment in 24.1% of adults and 36.9% of children. The outcome was similar for both age groups (remission, 32.5% of adults and 31.6% of children; renal function impairment, 31.6% of adults and 24.5% of children). Endstage renal disease was observed in 15.8% of adults and in 7% of children. Renal function survival at 5 years was not significantly different in the two groups (85% in adults and 95% in children) and at 10 years it was approximately 75% in both groups. None of the children died and adult survival was 97% at 5 years. In adults at presentation, renal function impairment (P < 0.02) as well as proteinuria higher than 1.5 g/day (P < 0.02) and hypertension (P < 0.001) were negative prognostic factors. Multivariate analysis stressed the main statistical relevance of proteinuria (relative risk 2.37, P < 0.02). Conversely, in children no definite level of proteinuria, hypertension or other data were found to be associated with poor prognosis.
  
  
  CONCLUSIONS
  Among patients with a clinical presentation which warrants renal biopsy, HSP nephritis has a similar prognosis in children and adults. The evolution is more predictable in adults than in children.
authors.affiliation: Nephrology and Dialysis Department, Regina Margherita Children's Hospital, Torino, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Coppo
authors.forename: G
authors.initials: G
authors.lastname: Mazzucco
authors.forename: L
authors.initials: L
authors.lastname: Cagnoli
authors.forename: A
authors.initials: A
authors.lastname: Lupo
authors.forename: F P
authors.initials: FP
authors.lastname: Schena
mesh_terms: D000328:Adult; D002648:Child; D006801:Humans; D006973:Hypertension / Q000150:complications; D011695:IgA Vasculitis / Q000150:complications*; D015999:Multivariate Analysis; D009393:Nephritis / Q000209:etiology*; D011379:Prognosis; D011507:Proteinuria / Q000150:complications; D012307:Risk Factors