The adult kidney 24 years after childhood Henoch-Schönlein purpura: a retrospective cohort study.
BACKGROUND
Henoch-Schönlein purpura arising in childhood could cause renal impairment or even an end-stage renal disease later in life. We aimed to assess long-term outcome of childhood Henoch-Schönlein purpura after 24 years.


METHODS
We studied a cohort of 26 boys and 26 girls who were treated for Henoch-Schönlein purpura at Helsinki University Hospital during 1964-83. Mean follow-up was 24.1 years (SD 6.0; 16.4-36.5). All participants were asked about their state of health in a questionnaire, and 47 (90%) were examined by a doctor. Patients' medical history data were obtained from health-care centres and regional hospitals.


RESULTS
Seven (35%) of 20 adults who had severe Henoch-Schönlein purpura and glomerulonephritis at onset had renal impairment as adults, compared with two (7%) of 27 with mild or no renal symptoms at onset (relative risk 4.7, 95% CI 1.3-18.7). Relative risk for a poor outcome was 5.0 in women (1.1-32.5) and 2.0 in men (0.2-17.5). All patients with no renal symptoms at onset had a good outcome after 24 years of follow-up. Severity of first kidney biopsy finding did not correlate with risk of a poor outcome. 16 (70%) of 23 pregnancies had been complicated by hypertension, proteinuria, or both. Five (56%) of the nine women with complicated pregnancies had a poor renal outcome.


CONCLUSIONS
Long-term follow-up of all patients who had Henoch-Schönlein purpura with severe renal symptoms at onset is needed during adulthood. All women who had even mild renal symptoms at onset of Henoch-Schönlein purpura should be carefully observed during and after pregnancy.
Ronkainen
Jaana
J
Department of Paediatrics and Adolescence, Oulu University Hospital, PO Box 23, FIN-90029 OYS, Oulu, Finland.
Nuutinen
Matti
M
Koskimies
Olli
O
D000328:Adult; D001794:Blood Pressure; D002648:Child; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D005921:Glomerulonephritis / Q000097:blood / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology / Q000652:urine; D006801:Humans; D011695:IgA Vasculitis / Q000453:epidemiology* / Q000473:pathology; D007668:Kidney / Q000473:pathology; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D017741:Survivors