Pediatric Nephrology

, Volume 13, Issue 9, pp 816–823 | Cite as

Clinical outcome of Schönlein-Henoch purpura nephritis in children

  • K. Schärer
  • R. Krmar
  • U. Querfeld
  • H. Ruder
  • R. Waldherr
  • F. Schaefer
CLINICAL NEPHROLOGY/Original Article

Abstract 

We studied the long-term outcome of 64 children with biopsy-proven Schönlein-Henoch purpura (SHP) nephritis over 1–23 years of follow-up. Overall renal survival 10 years after onset was 73%. Multivariate logistic regression analysis identified initial renal insufficiency (P=0.004), nephrotic syndrome (P=0.037), and the severity of histological alterations, as defined by the proportion of glomerular crescents (P=0.051), as significant independent predictors of progressive renal failure. Four patients followed for more than 19 years showed glomerular damage after transient recovery. Eight children with crescentic nephritis associated with a rapidly progressive course and/or persistent nephrotic syndrome were treated by at least seven sessions of plasma exchange (PE) within 16 weeks of onset of purpura. During treatment serum creatinine levels dropped in each patient from a mean of 2.3 to 1.1 mg/dl, followed by a rebound increase. Repeated courses of PE in 5 patients produced comparable responses. Four patients undergoing PE reached end-stage renal disease at 1.2.–3.7 years after onset, whilst 3 finally were in preterminal renal failure (creatinine 3.2–6.1 mg/dl after 7–13.5 years), and 1 patient reached a normal glomerular filtration rate. Our experience suggests that initial renal insufficiency is the best single predictor of the further clinical course in children with SHP nephritis. Early PE appears to delay the progression in some patients with severe, rapidly progressive forms of the disease.

Key words Schönlein-Henoch purpura Glomerulonephritis Hypertension Proteinuria Renal failure Plasma exchange 

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Copyright information

© IPNA - International Pediatric Nephrology Association New York, USA 1999

Authors and Affiliations

  • K. Schärer
    • 1
  • R. Krmar
    • 1
  • U. Querfeld
    • 2
  • H. Ruder
    • 3
  • R. Waldherr
    • 4
  • F. Schaefer
    • 1
  1. 1.Division of Pediatric Nephrology, University Children’s Hospital, Im Neuenheimer Feld 150, D-69120 Heidelberg, Germany Tel.: +49-6221-562396, Fax: +49-6221-564203DE
  2. 2.Division of Pediatric Nephrology, University Children’s Hospital Cologne, Cologne, GermanyDE
  3. 3.Division of Pediatric Nephrology, University Children’s Hospital Erlangen, Erlangen, GermanyDE
  4. 4.Department of Pathology, University of Heidelberg, Heidelberg, GermanyDE

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