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Outcome of Henoch–Schönlein purpura 8 years after treatment with a placebo or prednisone at disease onset

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Abstract

Background

Corticosteroids have been shown not to prevent the development of Henoch–Schönlein nephritis. However, long-term follow-up data are scarce.

Methods

The long-term outcome of patients in a randomized placebo-controlled prednisone study was evaluated 8 years later with a health questionnaire completed by 160/171 (94%) patients and by urine and blood pressure screening (138/171, 81%).

Results

Twelve patients had hematuria and/or proteinuria and seven had hypertension. The patients with nephritis at onset of Henoch–Schönlein purpura (HSP) had an increased risk of hypertension and/or urine abnormalities (odds ratio 3.6, p = 0.022, 95% confidence interval 1.3–10.0). There were no differences between the prednisone and placebo groups. Recurrences of purpura were reported by 15 patients, with some recurrences continuing for 10 years. All five reported pregnancies were complicated by proteinuria. Four patients presented with hematuria and/or proteinuria at the control visit, and four had hypertension. Of these, two had a decreased estimated glomerular filtration rate.

Conclusions

HSP has a good long-term prognosis in unselected patients, although skin relapses with/without late-onset nephritis may occur, even a decade after the initial disease. Urine and blood pressure abnormalities 8 years after HSP are associated with nephritis at its onset. Early prednisone treatment does not affect the outcome and should not be routinely used.

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Acknowledgments

We thank Helena Moilanen, a registered nurse, for helping in organizing the laboratory tests throughout the country. We also thank all of the health care centers and hospitals that helped us by screening the patients for this study. This work was supported by grants from the Alma and K. A. Snellman Foundation, Oulu, Finland, and the Finnish Kidney and Liver Association.

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Authors and Affiliations

  1. Department of Children and Adolescents, Oulu University Hospital, PO Box 23, 90029, Oulu, Finland

    Outi Jauhola & Matti Nuutinen

  2. Oulu City Health Care Centre, Oulu, Finland

    Jaana Ronkainen

  3. Children’s Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland

    Olli Koskimies, Tuula Hölttä & Timo Jahnukainen

  4. Department of Pediatrics, Tampere University Hospital, Tampere, Finland

    Marja Ala-Houhala

  5. Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland

    Pekka Arikoski

  6. Department of Pediatrics, Jorvi Hospital, Helsinki University Central Hospital, Espoo, Finland

    Jukka Rajantie

  7. Department of Pediatrics, Hyvinkää Hospital, Hyvinkää, Finland

    Timo Örmälä

Authors
  1. Outi Jauhola
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  2. Jaana Ronkainen
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  3. Olli Koskimies
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  4. Marja Ala-Houhala
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  6. Tuula Hölttä
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  7. Timo Jahnukainen
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  10. Matti Nuutinen
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Correspondence to Matti Nuutinen.

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Jauhola, O., Ronkainen, J., Koskimies, O. et al. Outcome of Henoch–Schönlein purpura 8 years after treatment with a placebo or prednisone at disease onset. Pediatr Nephrol 27, 933–939 (2012). https://doi.org/10.1007/s00467-012-2106-z

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  • DOI: https://doi.org/10.1007/s00467-012-2106-z

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