title: Even mild cases of paediatric Henoch-Schönlein purpura nephritis show significant long-term proteinuria.
abstract: OBJECTIVE
  Henoch-Schonlein purpura (HSP) is a common cause of paediatric renal disease in children, representing 10-15% of paediatric glomerulonephritis. This study examined the long-term outcome of biopsy-proven HSP nephritis to identify correlations between disease development and treatment.
  
  
  METHODS
  Patients from three French centres were retrospectively analysed.
  
  
  RESULTS
  We followed up 142 patients aged from 2 to 10.5 years with HSP nephritis, graded according to the International Study Group of Kidney Disease in Childhood classification. Mean (±SD) age at presentation was 7.6 ± 2.8 years. Nephrotic range proteinuria was present in 28% of patients with Grade II lesions, 60% with Grade III and 90% with Grade IV. Significant proteinuria (>0.5 g/L) was found in nine of 48 patients 3 years after renal biopsy, eight of 25 patients after 5 years and three of 14 patients after 10 years. There was no correlation between the proteinuria risk at 3, 5 or 10 years and the initial histological lesion or treatment modality. Treatment with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB) was linked to lower proteinuria, especially if it was started precociously.
  
  
  CONCLUSIONS
  Even mild forms of HSP nephritis risk significant long-term proteinuria. Very early introduction of ACEi/ARB may improve the long-term outcome independent of histological lesions.
authors.affiliation: Department of Paediatric Nephrology, Armand-Trousseau Hospital, APHP, Paris, France.|University Pierre and Marie Curie, Paris, France.
authors.forename: Elena
authors.initials: E
authors.lastname: Tudorache
authors.affiliation: Department of Paediatric Nephrology, Armand-Trousseau Hospital, APHP, Paris, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Azema
authors.affiliation: Department of Paediatric Nephrology, Armand-Trousseau Hospital, APHP, Paris, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Hogan
authors.affiliation: Department of Paediatric Nephrology, Armand-Trousseau Hospital, APHP, Paris, France.
authors.forename: Hala
authors.initials: H
authors.lastname: Wannous
authors.affiliation: Department of Paediatric Nephrology, Armand-Trousseau Hospital, APHP, Paris, France.
authors.forename: Bilal
authors.initials: B
authors.lastname: Aoun
authors.affiliation: Department of Paediatric Nephrology, CHU, Toulouse, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Decramer
authors.affiliation: Department of Paediatric Nephrology, Robert-Debré Hospital, APHP, Paris, France.|University Paris-Diderot, Paris, France.
authors.forename: Georges
authors.initials: G
authors.lastname: Deschênes
authors.affiliation: Department of Paediatric Nephrology, Armand-Trousseau Hospital, APHP, Paris, France.|University Pierre and Marie Curie, Paris, France.
authors.forename: Tim
authors.initials: T
authors.lastname: Ulinski
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D011695:IgA Vasculitis / Q000150:complications* / Q000188:drug therapy; D008297:Male; D009393:Nephritis / Q000150:complications* / Q000188:drug therapy; D011507:Proteinuria / Q000209:etiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors
keywords: Angiotensin receptor blockers; Angiotensin-converting enzyme inhibitors; Henoch-Schonlein purpura; Proteinuria; Renal biopsy