Stenosing ureteritis in a 7-year-old boy with Henoch-Schönlein purpura nephritis: A case report and review of the literature.
BACKGROUND
Urinary tract obstruction resulting from Henoch-Schönlein purpura (HSP) is an extremely rare urologic entity. If the genitourinary system is involved, it is primarily in the form of a focal proliferative glomerulonephritis. Stenosing disease has received little attention in the literature and treatment options are limited. Despite early intervention renal loss may be inevitable.


METHODS
A 7-year-old African American male presented with renal failure secondary to bilateral sclerosing ureteritis 1 month after initial presentation with HSP. There was significant disease progression and he required multiple procedures, ultimately bilateral ureterocalycostomies and a left nephrectomy.


CONCLUSIONS
HSP is an immune-mediated necrotizing vasculitis. It can affect any organ system; however, in the genitourinary system, focal proliferative glomerulonephritis is a common manifestation, occurring in 20-90% of cases [8]. Extrarenal manifestations are rare.


CONCLUSIONS
Ureteritis and obstruction may be late occurrences, but should be considered in all patients presenting with a history of HSP and new-onset flank pain, acute renal failure, or anuria. Families and patients should be counseled that renal impairment may be a consequence of stenosing ureteritis. Management of these patients can be complicated but surgical correction must be considered in the treatment algorithm once the disease has stabilized.
Corbett
Sean T
ST
Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA. stc2u@virginia.edu
Lennington
Jennifer N
JN
Chua
Annabelle N
AN
Gonzales
Edmond T
ET
D058186:Acute Kidney Injury / Q000209:etiology; D002648:Child; D018450:Disease Progression; D005921:Glomerulonephritis / Q000150:complications / Q000276:immunology / Q000628:therapy; D006801:Humans; D011695:IgA Vasculitis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D007249:Inflammation; D007668:Kidney / Q000473:pathology; D008297:Male; D009393:Nephritis / Q000150:complications* / Q000473:pathology / Q000628:therapy; D012598:Sclerosis; D014513:Ureter / Q000473:pathology*; D014517:Ureteral Obstruction / Q000150:complications* / Q000473:pathology