Late onset urinary abnormality in anaphylactoid purpura found by urinary screening

Henoch-Schönlein purpura in children. Report of 100 patients and review of the literature

Henoch-Schönlein purpura (HSP) is an acute leukocytoclastic vasculitis that primarily affects children. In the current report, the author presents the clinical features of 100 children with HSP and reviews the literature, placing particular emphasis on new information concerning the etiology, immunopathogenesis, and treatment of HSP. The dominant clinical features of HSP are cutaneous purpura (100%), arthritis (82%), abdominal pain (63%), gastrointestinal bleeding (33%), and nephritis (40%). The etiology of HSP remains unknown, but it is clear that IgA plays a critical role in the immunopathogenesis of HSP, as evidenced by increased serum IgA concentrations, IgA-containing circulating immune complexes, and IgA deposition in vessel walls and renal mesangium. There are 2 subclasses of IgA, but HSP is associated with abnormalities involving IgA1 exclusively, and not IgA2. This finding may be a consequence of abnormal glycosylation of O-linked oligosaccharides unique to the hinge region of IgA1 molecules. Although several lines of evidence suggest a genetic susceptibility to HSP, the fundamental basis for the abnormalities involving IgA remain unclear. In general, HSP is an acute, self-limited illness, but one-third of patients will have 1 or more recurrences of symptoms. Corticosteroid therapy may hasten the resolution of arthritis and abdominal pain, but does not prevent recurrences. To date, no form of therapy has been shown to shorten appreciably the duration of HSP. The long-term prognosis of HSP is directly dependent on the severity of renal involvement. Corticosteroids in usual doses have no effect on established nephritis. Evidence is emerging that treatment with high-dose intravenous pulse methylprednisolone coupled with azathioprine or cyclophosphamide may be beneficial in patients with severe nephritis.

Changes in the duration of the urinary abnormality of purpura nephritis over the past 5 years

BACKGROUND

The clinical features of patients with anaphylactoid purpura who were admitted to the National Tosei Hospital over the past 15 years were investigated to confirm whether the prognosis of renal involvement had improved.

RESULTS

Of the 107 patients admitted to hospital, 43 (40.2%) had urinary abnormalities. The patients with renal involvement were older (P < 0.05) compared to patients without nephritis. Over the last 5 years (1991-95), the duration of urinary abnormalities was significantly shorter than in the period from 1981 to 1990 (P < 0.05).

CONCLUSIONS

The duration of the urinary abnormality of nephritis complicating anaphylactoid purpura appears to be changing.