title: Renal manifestations of Henoch-Schonlein purpura in a 6-month prospective study of 223 children.
abstract: 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.
authors.affiliation: Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland.
authors.forename: Outi
authors.initials: O
authors.lastname: Jauhola
authors.forename: Jaana
authors.initials: J
authors.lastname: Ronkainen
authors.forename: Olli
authors.initials: O
authors.lastname: Koskimies
authors.forename: Marja
authors.initials: M
authors.lastname: Ala-Houhala
authors.forename: Pekka
authors.initials: P
authors.lastname: Arikoski
authors.forename: Tuula
authors.initials: T
authors.lastname: Hölttä
authors.forename: Timo
authors.initials: T
authors.lastname: Jahnukainen
authors.forename: Jukka
authors.initials: J
authors.lastname: Rajantie
authors.forename: Timo
authors.initials: T
authors.lastname: Ormälä
authors.forename: Juha
authors.initials: J
authors.lastname: Turtinen
authors.forename: Matti
authors.initials: M
authors.lastname: Nuutinen
mesh_terms: 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
chemical_list: D005938:Glucocorticoids; D011241:Prednisone