Skip to main content

Advertisement

Log in

Henoch Schonlein purpura in childhood: clinical analysis of 254 cases over a 3-year period

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

Abstract

We aimed to evaluate the patients who were diagnosed as Henoch Schonlein purpura (HSP) for disease characteristics and prognosis of those with joint, gastrointestinal (GI), and renal involvement. Two hundred and fifty-four children who were followed up with the diagnosis of HSP in the Pediatric Nephrology Clinics of Meram Medical Faculty of Selcuk University and Medical Faculty of Gazi University between January 2003 and June 2006 were retrospectively evaluated. The clinical follow-up and treatment regimens of patients in whom renal biopsy was performed were evaluated in detail. The study group consisted of 254 children, 147 boys (57.8%) and 107 girls (42.2%), and the ratio of boys to girls was 1.37. The percentages of skin, joint, GI, and renal manifestations were 100%, 66%, 56%, and 30%, respectively. Eight patients had intussusception. Five of them recovered with steroid treatment only while three patients were operated on. Sixty-four patients (44%) with GI involvement had severe disease and were successfully treated with steroids. Renal biopsy was performed in 26 patients. Among those 26 patients, two of them recovered spontaneously within 3 and 4 weeks. Ten patients improved with only steroid treatment while 12 patients recovered with steroid and cyclophosphamide treatment. Two patients were resistant to steroid and cyclophosphamide treatment and were treated with cyclosporine A. We believe that steroid therapy given to the HSP patients with GI manifestations might be helpful to prevent probable complications such as GI bleeding and intussusception. In addition, combined therapy with steroid and cyclophosphamide can usually be an appropriate treatment for patients with nephrotic proteinuria.

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

Access this article

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

References

  1. Saulsbury FT (2001) Henoch–Schonlein purpura. Curr Opin Rheumatol 13:35–40

    Article  PubMed  CAS  Google Scholar 

  2. Heberden W (1801) Commertarii de Malbaun. Historia et curatione. Payne, London

    Google Scholar 

  3. Schonlein JL (1837) Allgemenie und specielle Pathologie und Therapie, vol 2, 3rd edn. Herisau, Wurzburg

    Google Scholar 

  4. Henoch EH (1874) Uber eine eigentumliche Form von Purpura. Berliner Klinische Wochenschrift 2:641–643

    Google Scholar 

  5. Henoch EH (1895) Vorlesungen uber Kinderkrankheiten. Hirschwald, Berlin

    Google Scholar 

  6. Tizard EJ (2002) Henoch Schonlein purpura. Current Pediatrics 12:575–580

    Article  Google Scholar 

  7. Szer IS (2002) Henoch Schonlein purpura. Curr Opin Rheumatol 6:25–31

    Article  Google Scholar 

  8. Ronkainen J, Nuutinen M, Koskimies O (2002) The adult kidney 24 years after childhood Henoch–Schonlein purpura: a retrospective cohort study. Lancet 360:666–700

    Article  PubMed  Google Scholar 

  9. Ronkainen J, Ala-Houhala M, Huttunen NP et al (2003) Outcome of Henoch–Schonlein nephritis with nephrotic-range proteinuria. Clin Nephrol 60:80–84

    PubMed  CAS  Google Scholar 

  10. Goldstein AR, White RH, Akuse R et al (1992) Long term follow-up of childhood Henoch–Schonlein nephritis. Lancet 339:280–282

    Article  PubMed  CAS  Google Scholar 

  11. Ozen S (2002) The spectrum of vasculitis in children. Best Pract Res Clin Rheumatol 16(3):411–425

    PubMed  CAS  Google Scholar 

  12. Allen DM, Diamond LK, Howell DA (1960) Anaphylactoid purpura in children (Schonlein–Henoch syndrome). Am J Dis Child 99:833–854

    CAS  Google Scholar 

  13. Robson WL, Leung AK (1994) Henoch–Schonlein purpura. Adv Pediatr 41:163–194

    PubMed  CAS  Google Scholar 

  14. Saulsbury FT (1999) Henoch–Schonlein purpura in children. Report of 100 patients and review of the literature. Medicine (Baltimore) 78:395–409

    Article  CAS  Google Scholar 

  15. Sterky G, Thilen A (1960) A study on the onset and prognosis of acute vascular purpura (the Schonlein–Henoch syndrome) in children. Acta Paediatr 49:217–229

    Article  PubMed  CAS  Google Scholar 

  16. Calvino MC, Llorca J, Porrua GC et al (2001) Henoch–Schonlein purpura in children from northwestern Spain. Medicine 80:279–290

    Article  PubMed  CAS  Google Scholar 

  17. Sohar E, Gafni J, Pras M et al (1967) Familial Mediterranean fever. A survey of 470 cases and review of the literature. Am J Med 43:227–253

    Article  PubMed  CAS  Google Scholar 

  18. Glikson M, Galun E, Schlesinger M et al (1989) Polyarteritis nodosa and familial Mediterranean fever: a report of 2 cases and review of the literature. J Rheumatol 16:536–539

    PubMed  CAS  Google Scholar 

  19. Ozdogan H, Arısoy N, Kasapcapur O et al (1997) Vasculitis in familial Mediterranean fever. J Rheumatol 24:323–327

    PubMed  CAS  Google Scholar 

  20. Katz S, Borst M, Seekri I et al (1991) Surgical evaluation of Henoch–Schonlein purpura: experience with 110 children. Arch Surg 126:849–854

    PubMed  CAS  Google Scholar 

  21. Cull DL, Rosario V, Lally KP et al (1990) Surgical implications of Henoch–Schonlein purpura. J Pediatr Surg 25:741–743

    Article  PubMed  CAS  Google Scholar 

  22. Hamby LS, Fowler CL, Pokorny WJ (1996) Intussusception. In: Donellan WL, Burrington JD, Kimura K, Schafer JC, White JJ (eds) Abdominal surgery of infancy and childhood, 1st edn. Harwood, Luxembourg, pp 42/1–42/19

    Google Scholar 

  23. Martinez-Frontanilla LA, Silverman L, Meagher DP (1988) Intussusception in Henoch–Schonlein purpura: diagnosis with ultrasound. J Pediatr Surg 23:375–376

    Article  PubMed  CAS  Google Scholar 

  24. Rosenblum ND, Winter HS (1987) Steroid effects on the course of abdominal pain in children with Henoch–Schonlein purpura. Pediatrics 79:1018–1021

    PubMed  CAS  Google Scholar 

  25. Sonmez K, Turkyılmaz Z, Demirogulları B et al (2002) Conservative treatment for small intestinal intussusception associated with Henoch–Schonlein’s purpura. Surg Today 32:1031–1034

    Article  PubMed  Google Scholar 

  26. Wedgewood RJP, Klaus MH (1955) Anaphylactoid purpura. A long-term follow-up study with special reference to renal involvement. Pediatrics 16:196–206

    Google Scholar 

  27. Ostergaard JR, Storm K (1991) Neurologic manifestations of Schonlein–Henoch purpura. Act Pediatr Scand 80:339–342

    Article  CAS  Google Scholar 

  28. Stewart M, Savage JM, Bell B et al (1988) Long term renal prognosis of Henoch–Schonlein purpura in an unselected childhood population. Eur J Pediatr 147:113–115

    Article  PubMed  CAS  Google Scholar 

  29. Mollica F, Li Volti S, Garozzo R et al (1992) Effectiveness of early prednisone treatment in preventing the development of nephropathy in anaphylactoid purpura. Eur J Pediatr 51:140–44

    Article  Google Scholar 

  30. Vernier RL, Worthen HG, Peterson RD et al (1961) Anaphylactoid purpura. Pathology of the skin and kidney and frequency of streptococcal infection. Pediatrics 27:181–193

    PubMed  CAS  Google Scholar 

  31. Scharer K, Krmar R, Querfeld U et al (1999) Clinical outcome of Schonlein–Henoch purpura nephritis in children. Pediatr Nephrol 13:816–823

    Article  PubMed  CAS  Google Scholar 

  32. Habib R, Niaudet R, Levy M (1994) In: Tisher CC, Brenner BM (eds) Schonlein–Henoch purpura nephritis and IgA nephropathy. Renal pathology with clinical and functional correlations, 2nd edn. Lippincott, Philadelphia, pp 427–523

    Google Scholar 

  33. Haycock GB (1998) The nephritis of Henoch–Schönlein purpura. In: Cameron JS et al (ed) Oxford textbook of nephrology, 2nd edn. Oxford University Press, Oxford, pp 585–612

    Google Scholar 

  34. Kobayashi O, Wada H, Okawa K et al (1977) Schonlein–Henoch’s syndrome in children. Contrib Nephrol 4:48–71

    Google Scholar 

  35. Koskimies O, Mir S, Rapola J et al (1981) Henoch–Schonlein nephritis: long-term prognosis of unselected patients. Arch Dis Child 56:482–484

    Article  PubMed  CAS  Google Scholar 

  36. Zurowska AM, Wrzolkowa T, Uszycka-Karcz M (1985) Henoch–Schonlein nephritis in children—a clinico-pathological study. Int J Pediatr Nephrol 6:183–188

    PubMed  CAS  Google Scholar 

  37. Niaudet P, Murcia I, Beaufils H et al (1993) Primary IgA nephropathies in children: prognosis and treatment. Adv Nephrol 22:121–140

    CAS  Google Scholar 

  38. Yoshikawa N, Ito H, Yoshiya K et al (1987) Henoch–Schonlein nephritis and IgA nephropathy in children: a comparison of clinical course. Clin Nephrol 27:233–237

    PubMed  CAS  Google Scholar 

  39. Coppo R, Mazzucco G, Cagnoli L et al (1997) Long-term prognosis of Henoch Schonlein nephritis in adults and children. Nephrol Dial Transplant 12:2277–2283

    Article  PubMed  CAS  Google Scholar 

  40. Sano H, Izumida M, Shimizu H et al (2002) Risk factors of renal involvement and significant proteinuria in Henoch Schonlein purpura. Eur J Pediatr 161:196–201

    Article  PubMed  CAS  Google Scholar 

  41. Schmaldienst S, Winkler S, Breiteneder S et al (1997) Severe nephrotic syndrome in a patient with Schonlein–Henoch purpura: complete remission after cyclosporin A. Nephrol Dial Transplant 12:790–792

    Article  PubMed  CAS  Google Scholar 

  42. Catalano C, Fabbian F, Bordin V et al (1998) Failure of cyclosporine A in controlling Schonlein–Henoch purpura. Nephrol Dial Transplant 13:1605–1606

    Article  PubMed  CAS  Google Scholar 

  43. Ronkainen J, Harmainen HA, Nuutinen M (2003) Cyclosporin A for the treatment of severe Henoch–Schonlein glomerulonephritis. Pediatr Nephrol 18:1138–1142

    Article  PubMed  Google Scholar 

Download references

Conflict of interest statement

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Harun Peru.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Peru, H., Soylemezoglu, O., Bakkaloglu, S.A. et al. Henoch Schonlein purpura in childhood: clinical analysis of 254 cases over a 3-year period. Clin Rheumatol 27, 1087–1092 (2008). https://doi.org/10.1007/s10067-008-0868-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-008-0868-2

Keywords

Navigation