Predictive factors of severe henoch-schonlein nephritis in children: About 34 cases

##plugins.themes.academic_pro.article.main##

Ouns Naija
Jihene Bouzaraa
Rim Goucha-Louzir
Mohamed Rachid Lakhoua

Abstract

Background: Henoch Schonlein Purpura is the most frequent vasculitis in children. Renal involvement is variable. Renal manifestations vary from isolated microscopic hematuria to the association on nephrotic syndrome to nephritic syndrome.
Aim: To determine the predictors of severe Henoch – Schönlein nephritis.
Methods: Retrospective study over 15 years (1996-2010) of 34 chidren, with henoch-schonlein nephritis.
Results: Renal involvement was determined in 68.7%. Mean age was 7.23 years (3-14 years). Renal manifestations were variable. Moderate renal manifestations were noted in 15 cases. Microscopic hematuria was observed in 23.5% of cases and moderate proteinuria with or without hematuria is noted in 20.5% of cases. Severe nephritis was noted in 18 cases: nephrotic syndrome in 29.5 % and nephrotic syndrome associated to nephritic syndrome in 23.5%. Hypertension without urinary anomalies was observed in one case. In univariate analysis, factor predictive of severe nephritis were: male sex, macroscopic hematuria, biologic inflammatory syndrome and leukocytosis. In multivariate analysis, only the leukocytosis was predictor of severity.
Conclusion: In our study, only leukocytosis was predictor of severity in henoch-schönlein nephritis

Keywords:

Henoch Schönlein- Nephritis- Child- Prognosis

##plugins.themes.academic_pro.article.details##

References

  1. Bourdat MG. Néphropathie du purpura rhumatoïde. Dans Cochat P, Bérard E eds. Néphrologie pédiatrique. Paris : Wolters Kluwer 2011:229-31.
  2. Mir S, Yavascan O, Mutlubas F, Yeniay B, Sonmez F. Clinical outcome in children with Henoch-Schönlein nephritis. Pediatr Nephrol 2007; 22: 64-70.
  3. Pillebout E, Nochy D, Thervet E. Henoch-Schönlein purpura. Nephrol Ther 2009; 5:663-75.
  4. Sano H, Izumida M, Shimizu H, Ogawa Y. Risk factors of renal involvement and significant proteinuria in Henoch-Schönlein purpura. Eur J Pediatr 2002; 161:196-201.
  5. Shin JI, Park JM, Shin YH, Hwang DH, Kim JH, Lee JS. Predictive factors of nephritis, relapse and significant proteinuria in childhood Henoch-Schönlein purpura. Scand J Rheumatol 2006; 35:58-60.
  6. Hung SH, Yang YH, Lee CC, Wang LC, Lin YT, Chiang BL. Clinical predictors of self-limited urinalysis abnormality in childhood Henoch-Schönlein purpura nephritis. Acta Paediatr 2006;95:306-11
  7. Meadow SR, Glasgow EF, White RHR, Moncrieff MW, Cameron JS, Ogg CS. Schönlein-Henoch nephritis. Q J Med 1972; 41:241-58.
  8. Heaton JM, Turner DR, Cameron JS. Localization of glomerular deposits in Henoch-Schönlein nephritis. Histopathology 1977; 1:93-104.
  9. Saulsbury FT. Henoch-Schönlein purpura: report of 100 patients and review of the literature. Medicine (Baltimore) 1999; 78:395-409.
  10. Rostoker G. Schönlein nephritis purpura in children and adults: diagnosis, pathophysiology and management. BioDrugs 2001; 15:99-138.
  11. Goldstein AR, White RH, Akuse R, Chantler C. Long-term follow-up of childhood Henoch-Schönlein nephritis. Lancet 1992; 339:208-82.
  12. Ronkainen J, Nuutinen M, Koskimies O. The adult kidney 24 years after childhood Henoch-Schönlein purpura: a retrospective cohort study. Lancet 2002; 360:666-70.
  13. Kawasaki Y, Suzuki J, Sakai N et al. Clinical and pathological features of children with Henoch-Schönlein purpura nephritis: risk factors associated with poor prognosis. Clin Nephrol 2003; 60:153-60.
  14. Chemli J, Boukadida H, Kchaou H, Selmi H, Zouari N, Hassaynoun S. Purpura rhumatoïde de l'enfant dans le centre tunisien: étude Clinique et évolutive de 122 cas. Rev Maghr Pediatr 2003; 8:235-244.
  15. Assadi F. Childhood Henoch-Schönlein nephritis: a multivariate analysis of clinical features and renal morphology at disease onset. Iran J Kidney Dis 2009; 3:17-21.
  16. Garcia-Porrùa C, Calvino MC, Llorca J, Couselo JM, Gonzalez- Gay MA. Henoch-Schönlein purpura in children and adults: clinical differences in a defined population. Semin Arthritis Rheum 2002; 32:149-56.
  17. Jauhola O, Ronkainen J, Koskimies O et al. Renal manifestations of Henoch-Schönlein purpura in a 6-month prospective study of 223 children. Arch Dis Child 2010; 95:877-82.
  18. Kaku Y, Noshara K, Honda S. Renal involvement in Henoch- Schönlein purpura: a multivariate analysis of prognostic factors. Kidney Int 1998; 53:1755-9.
  19. De-Almeida JLJ, Campos LM, Paim LB, Leone C, Koch VH, Silva CA. Renal involvement in Henoch-Schönlein purpura: a multivariate analysis of initial prognostic factors. J Pediatr (Rio J) 2007;83:259-66.
  20. Bogdanovic R. Henoch-Schönlein purpura nephritis in children: risk factors, prevention and treatment. Acta Paediatr 2009; 98; 1882-9.
  21. Trapani S, Micheli A, Grisolia F, et al. Henoch-Schönlein purpura in childhood: epidemiological and clinical analysis of 150 cases over a 5-year period and review of literature. Semin Arthritis Rheum 2005; 35:143-53.