Renal manifestations of Henoch-Schonlein purpura in a 6-month prospective study of 223 children.
OBJECTIVE
To assess the risk factors for developing Henoch-Schönlein purpura nephritis (HSN) and to determine the time period when renal involvement is unlikely after the initial disease onset.


METHODS
A prospective study of 223 paediatric patients to examine renal manifestations of Henoch-Schönlein purpura (HSP). The patient's condition was monitored with five outpatient visits to the research centre and urine dipstick testing at home.


RESULTS
HSN occurred in 102/223 (46%) patients, consisting of isolated haematuria in 14%, isolated proteinuria in 9%, both haematuria and proteinuria in 56%, nephrotic-range proteinuria in 20% and nephrotic-nephritic syndrome in 1%. The patients who developed HSN were significantly older than those who did not (8.2±3.8 vs 6.2±3.0 years, p<0.001, CI for the difference 1.1 to 2.9). Nephritis occurred a mean of 14 days after HSP diagnosis, and within 1 month in the majority of cases. The risk of developing HSN after 2 months was 2%. Prednisone prophylaxis did not affect the timing of the appearance of nephritis. The risk factors for developing nephritis were age over 8 years at onset (OR 2.7, p=0.002, CI 1.4 to 5.1), abdominal pain (OR 2.1, p=0.017, CI 1.1 to 3.7) and recurrence of HSP disease (OR 3.1, p=0.002, CI 1.5 to 6.3). Patients with two or three risk factors developed nephritis in 63% and 87% of cases, respectively. Laboratory tests or blood pressure measurement at onset did not predict the occurrence of nephritis.


CONCLUSIONS
The authors recommend weekly home urine dipstick analyses for the first 2 months for patients with HSP. Patients with nephritis should be followed up for more than 6 months as well as the patients with HSP recurrence.
Jauhola
Outi
O
Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland.
Ronkainen
Jaana
J
Koskimies
Olli
O
Ala-Houhala
Marja
M
Arikoski
Pekka
P
Hölttä
Tuula
T
Jahnukainen
Timo
T
Rajantie
Jukka
J
Ormälä
Timo
T
Turtinen
Juha
J
Nuutinen
Matti
M
D000293:Adolescent; D017677:Age Distribution; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D004812:Epidemiologic Methods; D005938:Glucocorticoids / Q000627:therapeutic use; D006417:Hematuria / Q000209:etiology; D006801:Humans; D011695:IgA Vasculitis / Q000150:complications*; D009393:Nephritis / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D011241:Prednisone / Q000627:therapeutic use; D011379:Prognosis; D011507:Proteinuria / Q000209:etiology; D012008:Recurrence; D013997:Time Factors; D016482:Urinalysis / Q000379:methods
D005938:Glucocorticoids; D011241:Prednisone