Skip to main content
SpringerLink
Log in

Henoch-Schönlein purpura nephritis: initial risk factors and outcomes in a Latin American tertiary center

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

A Correction to this article was published on 29 January 2018

This article has been updated

Abstract

The objective of this study was to evaluate prevalence, initial risk factors, and outcomes in Henoch-Schönlein purpura nephritis (HSPN) patients in Latin America. Two hundred ninety-six patients (validated EULAR/PRINTO/PRES HSP criteria) were assessed by demographic data, clinical/laboratorial involvements, and treatments in the first 3 months after diagnosis. They were followed-up in a Latin American tertiary center and were divided in two groups: with and without nephritis. Persistent non-nephrotic proteinuria, nephrotic proteinuria, and acute/chronic kidney injury were also systematically evaluated at 1, 5, 10, and 15 years after diagnosis. HSPN was evidenced in 139/296 (47%) in the first 3 months. The median age at diagnosis was significantly higher in HSPN patients compared without renal involvement [6.6 (1.5–17.7) vs. 5.7 (0.9–13.5) years, p = 0.022]. The frequencies of persistent purpura (31 vs. 10%, p < 0.0001), recurrent abdominal pain (16 vs. 7%, p = 0.011), gastrointestinal bleeding (25 vs. 10%, p < 0.0001), and corticosteroid use (54 vs. 41%, p = 0.023) were significantly higher in the former group. Logistic regression demonstrated that the independent variables associated with HSNP were persistent purpura (OR = 3.601; 95% CI (1.605–8.079); p = 0.002) and gastrointestinal bleeding (OR = 2.991; 95% CI (1.245–7.183); p = 0.014). Further analysis of patients without HSPN in the first 3 months revealed that 29/118 (25%) had persistent non-nephrotic proteinuria and/or hematuria in 1 year, 19/61 (31%) in 5 years, 6/17 (35%) in 10 years and 4/6 (67%) in 15 years after diagnosis. None of them had chronic kidney injury or were submitted to renal replacement therapy. The present study observed HSPN in almost one half of patients in the first months of disease, and HSPN was associated with persistent purpura and gastrointestinal bleeding. One fourth of patients had nephritis only evidenced during follow-up without severe renal manifestations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Change history

  • 29 January 2018

    One of the author’s name on this article was incorrectly spelled as “Sylvia C. L. Fahrat” . The correct spelling is “Sylvia C. L. Farhat” and is now presented correctly in this article. The original article has been corrected.

References

  1. de Almeida JL, Campos LM, Paim LB, Leone C, Koch VH, Silva CA (2007) Renal involvement in Henoch-Schönlein purpura: a multivariate analysis of initial prognostic factors. J Pediatr 83:259–266

    Google Scholar 

  2. Ozen S, Acar-Ozen NP (2017) Recent advances in childhood vasculitis. Curr Opin Rheumatol 29(5):530–534. https://doi.org/10.1097/BOR.0000000000000424

    Article  CAS  PubMed  Google Scholar 

  3. Júnior CR, Yamaguti R, Ribeiro AM, Melo BA, Campos LA, Silva CA (2008) Hemorrhagic vesicle-bullous lesions in Henoch-Schönlein purpura and review of literature. Acta Reumatol Port 33(4):452–456

    PubMed  Google Scholar 

  4. Jauhola O, Ronkainen J, Koskimies O, Ala-Houhala M, Arikoski P, Holtta T, Jahnukainen T, Rajantie J, Ormala T, Nuutinen M (2010) Clinical course of extrarenal symptoms in Henoch-Schönlein purpura: a 6-month prospective study. Arch Dis Child 95(11):871–876. https://doi.org/10.1136/adc.2009.167874

    Article  PubMed  Google Scholar 

  5. Suehiro RM, Soares BS, Eisencraft AP, Campos LM, Silva CA (2007) Acute hemorrhagic edema of childhood. Turk J Pediatr 49(2):189–192

    PubMed  Google Scholar 

  6. Chan H, Tang YL, Lv XH, Zhang GF, Wang M, Yang HP, Li Q (2016) Risk factors associated with renal involvement in childhood Henoch-Schönlein purpura: a meta-analysis. PLoS One 11(11):e0167346. https://doi.org/10.1371/journal.pone.0167346

    Article  PubMed  PubMed Central  Google Scholar 

  7. Terreri MT, Campos LM, Okuda EM, Silva CA, Sacchetti SB, Marini R, Ferriani VP, Ventura MH, Fernandes T, Sato JO, Fernandes EC, Len C, Barbosa C, Lotito AP, Santos MC, Aikawa NE, Facó M, Piotto D, Bugni V, Kozu KT, Romanelli PR, Sallum AM, Febronio M, Fraga M, Magalhães CS (2013) Profile of paediatric rheumatology specialists and services in the state of São Paulo. Rev Bras Reumatol 53(4):346–351

    Article  PubMed  Google Scholar 

  8. Feng D, Huang WY, Hao S, Niu XL, Wang P, Wu Y, Zhu GH (2017) A single-center analysis of Henoch-Schonlein purpura nephritis with nephrotic proteinuria in children. Pediatr Rheumatol Online J 15(1):15. https://doi.org/10.1186/s12969-017-0146-4

    Article  PubMed  PubMed Central  Google Scholar 

  9. Soylemezoglu O, Ozkaya O, Ozen S, Bakkaloglu A, Dusunsel R, Peru H, Cetinyurek A, Yildiz N, Donmez O, Buyan N, Mir S, Arisoy N, Gur-Guven A, Alpay H, Ekim M, Aksu N, Soylu A, Gok F, Poyrazoglu H, Sonmez F, Turkish Pediatric Vasculitis Study Group (2009) Henoch-Schönlein Nephritis: a nationwide study. Nephron Clin Pract 112(3):c199–c204. https://doi.org/10.1159/000218109

    Article  CAS  PubMed  Google Scholar 

  10. Goldstein AR, White RH, Akuse R, Chantler C (1992) Long-term follow-up of childhood Henoch-Schonlein nephritis. Lancet 339(8788):280–282. https://doi.org/10.1016/0140-6736(92)91341-5

    Article  CAS  PubMed  Google Scholar 

  11. Ronkainen J, Nutinen M, Koskimies O (2002) The adult kidney 24 years after childhood Henoch-Schönlein purpura: a retrospective cohort study. Lancet 360(9334):666–670. https://doi.org/10.1016/S0140-6736(02)09835-5

    Article  PubMed  Google Scholar 

  12. Butani L, Morgenstern BZ (2007) Long-term outcome in children after Henoch-Schönlein purpura nephritis. Clin Pediatr 46(6):505–511. https://doi.org/10.1177/0009922806298896

    Article  Google Scholar 

  13. Mills JA, Michel BA, Bloch DA, Calabrese LH, Hunder GG, Arend WP, Edworthy SM, Fauci AS, Leavitt RY, Lie JT (1990) The American College of Rheumatology 1990 criteria for the classification of Henoch-Schönlein purpura. Arthritis Rheum 33(8):1114–1121

    Article  CAS  PubMed  Google Scholar 

  14. Ozen S, Pistorio A, Iusan SM, Bakkaloglu A, Herlin T, Brik R, Buoncompagni A, Lazar C, Bilge I, Uziel Y, Rigante D, Cantarini L, Hilario MO, Silva CA, Alegria M, Norambuena X, Belot A, Berkun Y, Estrella AI, Olivieri AN, Alpigiani MG, Rumba I, Sztajnbok F, Tambic-Bukovac L, Breda L, al-Mayouf S, Mihaylova D, Chasnyk V, Sengler C, Klein-Gitelman M, Djeddi D, Nuno L, Pruunsild C, Brunner J, Kondi A, Pagava K, Pederzoli S, Martini A, Ruperto N, for the Paediatric Rheumatology International Trials Organisation (PRINTO) (2010) EULAR/PRINTO/PRES criteria for Henoch-Schönlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II: final classification criteria. Ann Rheum Dis 69(5):798–806. https://doi.org/10.1136/ard.2009.116657

    Article  PubMed  Google Scholar 

  15. Zhao YL, Liu ZJ, Bai XM, Wang YC, Li GH, Yan XY (2015) Obesity increases the risk of renal involvement in children with Henoch-Schönlein purpura. Eur J Pediatr 174(10):1357–1363. https://doi.org/10.1007/s00431-015-2547-z

    Article  CAS  PubMed  Google Scholar 

  16. Elmas AT, Tabel Y (2016) Platelet counts in children with Henoch-Schonlein purpura—relationship to renal involvement. J Clin Lab Anal 3:71–74

    Article  Google Scholar 

  17. Mao Y, Yin L, Huang H, Zhou Z, Chen T, Zhou W (2014) Henoch-Schönlein purpura in 535 Chinese children: clinical features and risk factors for renal involvement. J Int Med Res 42(4):1043–1049. https://doi.org/10.1177/0300060514530879

    Article  PubMed  Google Scholar 

  18. Nickavar A, Mehrazma M, Lahouti A (2012) Clinicopathologic correlations in Henoch-Schonlein nephritis. Iran J Kidney Dis 6(6):437–440

    PubMed  Google Scholar 

  19. Wang X, Zhu Y, Gao L, Wei S, Zhen Y, Ma Q (2016) Henoch-Schonlein purpura with joint involvement: analysis of 71 cases. Pediatr Rheumatol 14(1):20. https://doi.org/10.1186/s12969-016-0080-x

    Article  Google Scholar 

  20. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114(2):555–576. https://doi.org/10.1542/peds.114.2.S2.555

    Article  Google Scholar 

  21. Chan JC, Williams DM, Roth KS (2002) Kidney failure in infants and children. Pediatr Rev 23(2):47–60. https://doi.org/10.1542/pir.23-2-47

    Article  PubMed  Google Scholar 

  22. Akcan-Arikan A, Zappitelli M, Loftis LL, Washburn KK, Jefferson LS, Goldstein SL (2007) Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int 71(10):1028–1035. https://doi.org/10.1038/sj.ki.5002231

    Article  CAS  PubMed  Google Scholar 

  23. National Kidney Foundation (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39:S1–266

    Google Scholar 

  24. Working Group of the International IgA Nephropathy Network and the Renal Pathology Society, Cattran DC, Coppo R, Cook HT, Feehally J, Roberts IS, Troyanov S, Alpers CE (2009) The Oxford classification of IgA nephropathy: rationale, clinicopathological correlations, and classification. Kidney Int 76:534–545

    Article  Google Scholar 

  25. Modi S, Mohan M, Jennings A (2016) Acute scrotal swelling in Henoch-Schönlein purpura: case report and review of the literature. Urol Case Rep 6:9–11. https://doi.org/10.1016/j.eucr.2016.01.004

    Article  PubMed  PubMed Central  Google Scholar 

  26. Ha TS, Lee JS (2007) Scrotal involvement in childhood Henoch-Schönlein purpura. Acta Paediatr 96(4):552–555. https://doi.org/10.1111/j.1651-2227.2006.00173.x

    Article  PubMed  Google Scholar 

  27. Pacheva IH, Ivanov IS, Stefanova K et al (2017) Central nervous system involvement in Henoch-Schonlein purpura in children and adolescents. Case Rep Pediatr 2017:5483543

    PubMed  PubMed Central  Google Scholar 

  28. Kiryluk K, Moldoveanu Z, Sanders JT, Eison TM, Suzuki H, Julian BA, Novak J, Gharavi AG, Wyatt RJ (2011) Aberrant glycosylation of IgA1 is inherited in both pediatric IgA nephropathy and Henoch-Schönlein purpura nephritis. Kidney Int 80(1):79–87. https://doi.org/10.1038/ki.2011.16

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Chen JY, Mao JH (2015) Henoch-Schönlein purpura nephritis in children: incidence, pathogenesis and management. World J Pediatr 11(1):29–34. https://doi.org/10.1007/s12519-014-0534-5

    Article  CAS  PubMed  Google Scholar 

  30. Hetland LE, Susrud KS, Lindahl KH, Bygum A (2017) Henoch-Schönlein purpura: a literature review. Acta Derm Venereol 2017:27

    Google Scholar 

  31. Calviño MC, Llorca J, García-Porrúa C, Fernández-Iglesias JL, Rodriguez-Ledo P, González-Gay MA (2001) Henoch-Schönlein purpura in children from northwestern Spain: a 20-year epidemiologic and clinical study. Medicine 80(5):279–290. https://doi.org/10.1097/00005792-200109000-00001

    Article  PubMed  Google Scholar 

  32. Anil M, Aksu N, Kara OD, Bal A, Anil AB, Yavaşcan O, Un B (2009) Henoch-Schönlein purpura in children from western Turkey: a retrospective analysis of 430 cases. Turk J Pediatr 51(5):429–436

    PubMed  Google Scholar 

  33. Shin JI, Park JM, Shin YH, Hwang DH, Kim JH, Lee JS (2006) Predictive factors for nephritis, relapse, and significant proteinuria in childhood Henoch-Schönlein purpura. Scand J Rheumatol 35(1):56–60. https://doi.org/10.1080/03009740510026841

    Article  CAS  PubMed  Google Scholar 

  34. Sano H, Izumida M, Shimizu H, Ogawa Y (2002) Risk factors of renal involvement and significant proteinuria in Henoch-Schönlein purpura. Eur J Pediatr 161(4):196–201. https://doi.org/10.1007/s00431-002-0922-z

    Article  CAS  PubMed  Google Scholar 

  35. Coppo R, Andrulli S, Amore A et al (2006) Predictors of outcome in Henoch-Schönlein nephritis in children and adults. Am J Kidney Dis 47(6):993–1003. https://doi.org/10.1053/j.ajkd.2006.02.178

    Article  PubMed  Google Scholar 

  36. Tudorache E, Azema C, Hogan J, Wannous H, Aoun B, Decramer S, Deschênes G, Ulinski T (2015) Even mild cases of paediatric Henoch-Schönlein purpura nephritis show significant long-term proteinuria. Acta Paediatr 104(8):843–848. https://doi.org/10.1111/apa.12723

    Article  CAS  PubMed  Google Scholar 

  37. Kim CH, Lim BJ, Bae YS et al (2014) Using the Oxford classification of IgA nephropathy to predict long-term outcomes of Henoch-Schönlein purpura nephritis in adults. Mod Pathol 27(7):972–982. https://doi.org/10.1038/modpathol.2013.222

    Article  CAS  PubMed  Google Scholar 

  38. Tudorache E, Azema C, Hogan J et al (2014) Even mild cases of paediatric Henoch-Schönlein purpura nephritis show significant long-term proteinuria. Acta Paediatr 104:843–848

    Article  PubMed  Google Scholar 

  39. Narchi H (2005) Risk of long term renal impairment and duration of follow up recommended for Henoch-Schonlein purpura with normal or minimal urinary findings: a systematic review. Arch Dis Child 90(9):916–920. https://doi.org/10.1136/adc.2005.074641

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pediatric Rheumatology Unit, Children’s Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil

    Izabel M. Buscatti, Beatriz B. Casella, Nadia E. Aikawa, Sylvia C. L. Farhat, Lucia M. A. Campos & Clovis Artur Silva

  2. Pediatric Nephrology Unit, Children’s Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil

    Andrea Watanabe

  3. São Paulo, Brazil

    Clovis Artur Silva

Authors
  1. Izabel M. Buscatti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Beatriz B. Casella
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nadia E. Aikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andrea Watanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sylvia C. L. Farhat
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lucia M. A. Campos
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Clovis Artur Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

Ethics declarations

The Ethics Committee of our University Hospital approved this study, and informed consent was obtained from all patients and their legal guardians

Disclosures

None.

Additional information

One of the author’s name on this article was incorrectly spelled as “Sylvia C. L. Fahrat”. The correct spelling is “Sylvia C. L. Farhat” and is now presented correctly in this article.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Buscatti, I.M., Casella, B.B., Aikawa, N.E. et al. Henoch-Schönlein purpura nephritis: initial risk factors and outcomes in a Latin American tertiary center. Clin Rheumatol 37, 1319–1324 (2018). https://doi.org/10.1007/s10067-017-3972-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-017-3972-3

Keywords

Search

Navigation