Clinical Features of Children With Henoch-Schonlein Purpura Risk Factors Associated With Renal Involvement

ArticleinIranian journal of kidney diseases 6(4):269-74 · July 2012with18 Reads
Source: PubMed
Abstract
This study aimed to evaluate renal involvement and factors affecting the prognosis in patients with Henoch-Schonlein purpura (HSP). The outcomes of 107 children diagnosed with HSP who had been followed up for at least 6 months were reviewed. Renal involvement was observed in 26.1% of the patients. The mean age of the patients with renal involvement was 8.8 ± 4.0 years as compared to 7.1 ± 2.9 years in the patients without renal involvement (P = .02). The risk of renal involvement was found to be significantly higher in the patients who were 10 years old and over (P < .001). In the group with renal involvement, the frequency of scrotal involvement was significantly higher than that of the group without renal involvement (P = .02). The mean serum immunoglobulin A level of the patients with renal involvements was significantly higher (P = .04) and the mean serum complement C3 levels was significantly lower (P = .04) than those of the patients without renal involvement. None of the patients with renal involvement reached end-stage kidney failure. No significant relationship was observed between the development of renal involvement and early steroid treatment. This study proposes that in old children with HSP, elevated serum immunoglobulin A levels, decreased serum complement C3 levels, and scrotal involvement are associated with renal involvement. We failed to find any effect of steroid treatment on development of renal involvement.
    • "Compared to patients without these above risk factors, presence of these factors was associated with 38.42 times, 5.08 times, 4.09 times higher incidence rates, respectively. Tabel et al. [24] also reported scrotal involvement as a risk factor for renal impairment. A study Elmas et al. [25] also showed an association of gastrointestinal symptoms with kidney damage. "
    [Show abstract] [Hide abstract] ABSTRACT: Although joint involvement is the second most common clinical manifestation after skin involvement in patients with Henoch-Schönlein purpura (HSP), it has not been well characterized. The aim of this study was to profile the clinical characteristics and identify the potential risk factors for kidney damage in HSP patients having joint involvement. We retrospectively reviewed 71 cases of HSP patients with joint involvement who attended our hospital between January 2010 and March 2012 and analyzed their epidemiological profile, clinical characteristics, follow-up findings (up to three years) and overall prognosis. Logistic regression analysis was performed to identify risk factors associated with renal symptoms in HSP patients with joint involvement. Average age of patients was 8.55 ± 2.13 years with male to female ratio at 1.29:1. The peak age of disease onset was six to 11 years. The most common triggers included upper respiratory infection, vigorous physical activity, and autumn and winter seasons. Forty cases (56.35 %) had gastrointestinal involvement and 37 (52.11 %) had kidney damage; gastrointestinal system, scrotal involvement, and increased D-dimer levels were significantly associated with kidney injury (P < 0.05) by multivariate analysis. Glucocorticoid therapy was effective in alleviating symptoms. Gastrointestinal symptoms, scrotal involvement, and increased D-dimer are the potential risk factors for kidney damage in HSP patients having joint involvement. Rational use of corticosteroids was probably responsible for the good clinical outcomes.
    Full-text · Article · Dec 2016
    • "We found that the mean age at the diagnosis of HSP in our cohort was 7.5 years, which is similar to that reported in a cohort of children with HSP at a university hospital in Turkey [8]. Lardhi, 2012 [7], on the other hand reported that the mean age at diagnosis was 6.3 years for patients who were followed up at King Fahad University Hospital in the eastern province of Saudi Arabia. "
    Full-text · Article · Jan 2015
    • "A distinct seasonal pattern in disease onset is the most prominent epidemiological characteristic of pediatric IgA vasculitis. Numerous observations from case series and longitudinal population-based surveys consistently support increased childhood IgA vasculitis during the fall [15,16,18192025, 26,28,29] and winter [15,181920 and a nadir in the summer months [18,31,33] . The fall-winter incidence peak, which is approximately twice as high as that in the summer [20], suggests a climate-related environmental trigger, particularly for infections. "
    [Show abstract] [Hide abstract] ABSTRACT: Purpose of review: To review the current knowledge of epidemiological features of immunoglobulin (Ig) A vasculitis (Henoch-Schönlein) and disease etiology. Recent findings: The annual incidence of IgA vasculitis in the population is an estimated 3-26.7/100 000 for children and infants and 0.8-1.8/100 000 for adults. These may be conservative approximations of the true frequency because of skewed case-finding strategies. In children, the marked autumn-winter peak in incidence rates, the frequent occurrence after an upper respiratory tract infection and the short interval between disease onset in index cases and in other family members collectively point to a transmissible infectious process. A subset of adult IgA vasculitis could be related to preceding or concurrent malignancies. Despite several lines of evidence supporting the critical role of an exogenous factor in IgA vasculitis, recent progress has been made in understanding the genetic susceptibility to IgA vasculitis. Recent findings also lessened the suggestion that IgA vasculitis might be triggered by vaccination. Summary: IgA vasculitis is two to 33 times more common in children than adults and appears to have a strong environmental component, with possibly different risk factors in childhood and adulthood. Support is strengthening for a role of genetics in IgA vasculitis.
    Full-text · Article · Jan 2013
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