Henoch-SchÖnlein purpura nephritis in children: Prognosis and treatment experiences

Abstract

© 2017, University of Kragujevac, Faculty of Science. All rights reserved. Henoch-Schonlein purpura is a type of systemic small vessel vasculitis. The dominant manifestation is the cutaneous component, the illness is self-limiting in nature, and the prognosis and outcome depend mostly on renal manifestations. We analysed the associations among clinical and laboratory parameters with the prognosis and outcome of HSP in children hospitalised at the Paediatrics clinic, Clinical Centre, Kragujevac between January 2011 and January 2012. Children who developed nephritis were older on average and all manifested with arthritis, abdominal complaints, microhaematuria, elevated D-dimer levels in the serum, and significant proteinuria and microalbuminuria (≥ 300 mg/L), and two children had pre-existing allergic conditions. All three children with repeatedly positive proteins in the morning sample urine test had significant proteinuria (≥0,5 g/24 h) and microalbuminuria (≥ 300 mg/L). These children had more bursts of rash and more severe and lasting abdominal pain and arthritis compared to children with normal urine tests. They were therefore treated with glucocorticoids and an angiotensin-converting enzyme inhibitor. The glomerular filtration rate measured by determining creatinine clearance was normal in all patients. These patients were diagnosed with Henoch-Schonlein purpura nephritis, and their condition was regularly monitored. Analysis of this group of patients demonstrated that the average age of 8 years and abdominal complaints were indicative of nephritis development.. Because both of these parameters are easily noted at disease onset, we suggest careful monitoring of disease course in these children.