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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR Table of Contents   
Year : 1996  |  Volume : 7  |  Issue : 1  |  Page : 34-35
Renal Involvement in Henoch-Schonlein Purpura


Pediatric Department, King Hussein Medical Center, P.O. Box 232, Amman 11954, Jordan

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How to cite this article:
Al Aun M, Njada AE, Hazza I, Al Hamoori M, Kudah E, Al Maghribi H. Renal Involvement in Henoch-Schonlein Purpura. Saudi J Kidney Dis Transpl 1996;7:34-5

How to cite this URL:
Al Aun M, Njada AE, Hazza I, Al Hamoori M, Kudah E, Al Maghribi H. Renal Involvement in Henoch-Schonlein Purpura. Saudi J Kidney Dis Transpl [serial online] 1996 [cited 2020 Sep 20];7:34-5. Available from: http://www.sjkdt.org/text.asp?1996/7/1/34/39538
To the Editor:

Henoch-Schonlein Purpura (HSP) repre­sents an important cause of nephritis in children. It is the degree of glomerular involvement which determines the long­term morbidity and mortality. The exact prevalence of renal involvement is unknown, but varies between 20-100% [1],[2],[3],[4],[5] , depending on the adequacy of investigations. HSP has its highest incidence at 4-5 years of age, and children younger than two years of age are rarely affected or experience a milder course of illness [6],[7] , while those above five years tend to develop severe renal involvement [5] . Seventy five percent of patients with HSP have upper respiratory tract infection preceding the onset. Streptococcal infections have been impli­cated [8] , however, casual relationship between group A streptococci and HSP is not supported [6],[9] .

The medical records of 55 patients with HSP, admitted to our hospital in the period from July 1989 through July 1994, were reviewed. Anti streptolysin-0 titer (ASOT), was measured in all patients. Also, all patients had blood urea nitrogen, serum creatinine and serum albumin measured at least once. Urinalysis for albumin, red blood cells and casts were performed daily during hospital stay.

The age of our patients was between 2.5 - 14 years. There were 30 males and 25 females. Thirty three of them were six years of age or less (group I) and 22 patients above six years of age (group II) at the time of presentation. Eighteen patients (33%), nine in each age group, showed evidence of renal involvement. Ten of them (56%) (six in group I and four in group II) had micro­scopic hematuria and albuminuria. Five patients (28%) had macroscopic hematuria, and three patients (17%) had acute nephritis. All the three patients with acute nephritis were above the age of six years and had ASOT > 00 I.U.

ASOT > 300 IU was found in only 11 patients with HSP. Of these three had acute nephritis as mentioned earlier, two had microscopic hematuria and albuminuria and five had no renal involvement [Table - 1].

Clinical expression of renal disease in HSP ranges from transient isolated micro­scopic hematuria to rapidly progressive glomerulonephritis. The most common renal manifestation is hematuria which is detected in nearly all cases.

Severe renal involvement tends to occur in children over the age of five years [5] . Renal involvement in our series was found in 27% and 41% in group I and group II respectively. None of the patients with acute nephritis was below six years. Studies have shown that the incidence of elevated streptococcal antibodies in patients with HSP was not higher than matched controls [6] . However, it seems that coincidental recent streptococcal infection increases the frequency and severity of renal involvement in HSP.

Persistent nephropathy may occur in about 1% of all cases, of which 1% may progress to end stage renal failure [10] . Habib and Levey [11] reported that in France HSP represented 15% of glomerular nephropathy in children. In our study none of our children had persistent renal involvement or chronic renal failure on a five year follow­-up period.

 
   References Top

1.Hughes LA, Wenzl JE. Anaphylactoid purpura nephritis in children. Data from a follow-up study. Clin Pediatr Phila 1969;8:594-6.  Back to cited text no. 1    
2.Koskimies O, Mir S, Rapola J, Vilska J. Henoch Schonlein nephritis: long-term prognosis of unselected patients. Arch Dis Child 1981;56:482-4.  Back to cited text no. 2    
3.Marchal A, Bost M, Dieterlen M, et al. Syndrome de Schonlein-Henoch de Tenfant. Ann Pediatr (Paris) 1974; 128:74.  Back to cited text no. 3    
4.Marx K. Henoch purpura revisited. Am J Dis Child 1974;128:74-7.  Back to cited text no. 4    
5.Meadow SR, Glasgow EF, White RH, Monerieff MW, Cameron JS, Ogg CS. Schonlein-Henoch nephritis. Q J Med 1972;41:241-58.  Back to cited text no. 5    
6.Austin HA3d, Balow. JE, Henoch ­Schonlein nephritis: prognostic features and the challenge of therapy. Am J Kidney Dis 1983;2:512-20.  Back to cited text no. 6    
7.Aleen DM. Diamond LK, Howell DA. Anaphylactoid purpura in children. Am J Dis Child 1960;99:853.  Back to cited text no. 7    
8.Gairdner D. The Henoch-Schonlein syndrome. Q J Med 1946;17:95.  Back to cited text no. 8    
9.Ayoub EM, Hoyer J. Anaphylactoid purpura: streptococcal antibody titres and beta 1C globulin levels. J Pediatr 1969;75:193-201.  Back to cited text no. 9    
10.Stewart M, Savage JM, Bell B, McCord B. Long term renal prognosis of Henoch­ Schonlein purpura in an unselected childhood population. Eur J Pediatr 1988;147:113-5.  Back to cited text no. 10    
11.Habib R, Levy M. Anaphylactoid purpura nephritis: observations with sixty children cases. Clin Pediatr Phila 1973;12:445-6.  Back to cited text no. 11    

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Correspondence Address:
Matrouk Al Aun
Pediatric Department, King Hussein Medical Center, P.O. Box 232, Amman 11954
Jordan
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PMID: 18417915

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