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Sunar Yayla EN, Bakkaloğlu SA. Does age at disease onset affect the clinical presentation and outcome in children with immunoglobulin A vasculitis? Arch Rheumatol 2023; 38:633-641. [PMID: 38125056 PMCID: PMC10728748 DOI: 10.46497/archrheumatol.2023.9914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/09/2023] [Indexed: 12/23/2023] Open
Abstract
Objectives The study aimed to determine whether there is a relationship between the age at diagnosis and the clinical, laboratory, and prognostic features in pediatric immunoglobulin A vasculitis (IgAV) patients. Patients and methods In this study, 539 pediatric IgAV patients (298 males, 241 females; mean age: 7.74±3.36 years; range, 1 to 17.8 years) were retrospectively evaluated between January 2005 and July 2020. The relationship between clinical findings and age at diagnosis was analyzed by univariate logistic regression analysis. Factors associated with renal involvement, steroid-dependent or refractory disease, and recurrence were examined. Results The median age of diagnosis was 7.1 (1-17.8) years in all patients. At the time of admission, purpura, abdominal pain, and arthritis were the most common clinical findings. At the time of diagnosis, there was a positive association between age and purpura and an inverse association with the presence of arthritis. There were associations between renal involvement and age at diagnosis (odds ratio=1.22, 95% confidence interval 1.13-1.31, p<0.001), follow-up time (p<0.001), no history of previous infection (p<0.001), and presence of gastrointestinal (GI) involvement (p=0.003). Significant relationships were found between the age at diagnosis, follow-up time, GI involvement, renal involvement, scrotal involvement, the C-reactive protein value at the time of diagnosis, and the presence of steroid-dependent disease. An association was found between recurrence and GI involvement. All refractory patients had renal involvement. Age at diagnosis (p<0.001) and follow-up time (p<0.001) was found to be associated with refractory disease. Conclusion Age at diagnosis and follow-up time may be associated with renal involvement and refractory and steroid-dependent disease in IgAV. In addition, there may be a relationship between steroid-dependent disease and renal, GI, and scrotal involvement and between GI involvement and recurrence.
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Affiliation(s)
- Emine Nur Sunar Yayla
- Department of Pediatrics, Division of Pediatric Rheumatology, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Sevcan A. Bakkaloğlu
- Department of Pediatrics, Division of Pediatric Rheumatology, Gazi University Faculty of Medicine, Ankara, Türkiye
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2
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Marro J, Williams C, Pain CE, Oni L. A case series on recurrent and persisting IgA vasculitis (Henoch Schonlein purpura) in children. Pediatr Rheumatol Online J 2023; 21:85. [PMID: 37580746 PMCID: PMC10424434 DOI: 10.1186/s12969-023-00872-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/02/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND IgA vasculitis (IgAV) is a small vessel vasculitis that is more common in childhood. Very limited evidence exists on patients who experience an atypical disease course. The aim of this study was to describe a cohort of children diagnosed with recurrent or persisting IgAV to identify any themes associated with their disease course and areas of unmet needs. METHODS A single centre retrospective study of children diagnosed with recurrent or persisting IgAV at Alder Hey Children's Hospital (Liverpool, UK). Clinical data, including features at presentation and during follow up, potential triggers, abnormal laboratory and histology results, treatment and outcome at last clinical review were retrospectively collected. Key themes were identified. RESULTS A total of 13 children met the inclusion criteria (recurrent disease, n = 4; persisting disease, n = 9). Median age at first presentation was 10.2 years [2.6-15.5], female:male ratio 1.2:1. Children in the atypical cohort were significantly older than a larger cohort of children who followed a non-complicated disease course (median age 5.5 years (range [0.6-16.7], p = 0.003)). All children re-presented with a purpuric rash (either recurring or persisting), accompanied by joint involvement in 92% of patients (12/13). Disease-modifying anti-rheumatic drugs (DMARDs) were used in 8/13 (62%) children. The median time from first presentation to diagnosis of atypical disease was 18.4 months [5.3-150.8] and the time from first presentation to treatment was 24.1 months [1.8-95.4]. Use of corticosteroids was significantly higher in children with renal involvement (p = 0.026). During follow up, 8/13 (62%) children were admitted at least once, whilst 10/13 (77%) had re-presented at least once to the emergency department. Five (38%) children were referred to psychology services and 7 (54%) children reported feelings of frustration. CONCLUSIONS This series describes some characteristics of a small cohort of children with atypical IgAV. It also identifies unmet needs in children with atypical IgAV, which includes delays in diagnosis and lengthy waits for treatment, lack of high-quality evidence regarding treatment choices and a high unrecognised disease burden. Further research is needed to study this subgroup of children as evidence is lacking.
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Affiliation(s)
- Julien Marro
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Chloe Williams
- Royal Liverpool and Broadgreeen University Hospital Trusts, Liverpool, UK
| | - Clare E Pain
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Louise Oni
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
- Department of Paediatric Nephrology, University of Liverpool Alder Hey Children's NHS Foundation Trust Hospital, Institute in the Park Building, Eaton Road, Liverpool, L12 2AP, UK.
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Carucci NS, La Barbera G, Peruzzi L, La Mazza A, Silipigni L, Alibrandi A, Santoro D, Chimenz R, Conti G. Time of Onset and Risk Factors of Renal Involvement in Children with Henoch-Schönlein Purpura: Retrospective Study. CHILDREN 2022; 9:children9091394. [PMID: 36138703 PMCID: PMC9497900 DOI: 10.3390/children9091394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/25/2022] [Accepted: 09/13/2022] [Indexed: 11/27/2022]
Abstract
Background: Henoch-Schönlein purpura (HSP) is a common systemic vasculitis in children, involving the skin, musculoskeletal system, gastrointestinal tract and kidneys. Some studies in children have shown possible risk factors linked with the development and severity of HSP Nephritis (HSPN). The aim of this study was to research predicting factors for the development of HSPN. Methods: We retrospectively evaluated 132 pediatric patients with HSP, according to EULAR/PRINTO/PRESS criteria. All patients were screened for HSPN by urinalysis. Finally, we compared demographic, clinical and laboratory data in HSP patients with and without nephritis. Results: The median age at HSP diagnosis [6.2 (2.6–17.5) vs. 5.5 (0.8–15.4) years, p = 0.03] and the incidence of abdominal pain (48 vs. 27%, p = 0.01) were significantly higher in HSPN patients. No differences were evidenced regarding gender, allergic diseases, skin recurrences, gastrointestinal involvement, musculoskeletal involvement, scrotal involvement, and laboratory data (white blood cell count, neutrophil count, lymphocyte count, platelet count, C-reactive protein, erythrocyte sedimentation rate, and blood concentration of IgA). Conclusions: The age at diagnosis and abdominal pain were independent risk factors for renal involvement in HSP patients. However, due to the retrospective nature of this study, further long-term and prospective studies will be necessary.
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Affiliation(s)
- Nicolina Stefania Carucci
- Pediatric Nephrology and Rheumatology Unit, AOU G Martino, University of Messina, 98125 Messina, Italy
| | - Giulia La Barbera
- Pediatric Nephrology and Rheumatology Unit, AOU G Martino, University of Messina, 98125 Messina, Italy
| | - Licia Peruzzi
- Pediatric Nephrology Unit, Regina Margherita Department, Azienda Ospedaliero-Universitaria Città Della Salute E Della Scienza, 10126 Torino, Italy
- Correspondence:
| | - Antonella La Mazza
- Pediatric Nephrology and Rheumatology Unit, AOU G Martino, University of Messina, 98125 Messina, Italy
| | - Lorena Silipigni
- Pediatric Nephrology and Rheumatology Unit, AOU G Martino, University of Messina, 98125 Messina, Italy
| | - Angela Alibrandi
- Unit of Statistical and Mathematical Sciences, Department of Economics, University of Messina, 98125 Messina, Italy
| | - Domenico Santoro
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy
| | - Roberto Chimenz
- Pediatric Nephrology and Rheumatology Unit, AOU G Martino, University of Messina, 98125 Messina, Italy
| | - Giovanni Conti
- Pediatric Nephrology and Rheumatology Unit, AOU G Martino, University of Messina, 98125 Messina, Italy
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Liu C, Luo L, Fu M, Li Z, Liu J. Analysis of children with Henoch-Schonlein purpura secondary to infection. Clin Rheumatol 2022; 41:803-810. [PMID: 34993728 DOI: 10.1007/s10067-021-06007-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/26/2021] [Accepted: 11/26/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Henoch-Schonlein purpura (HSP) is the most common childhood vasculitis, infection is the most essential inducement. We hypothesized that infection could impact the blood routine characteristics and/or outcome of vasculitis. Thus, we aim to find the most common infectious agent in HSP patients and identify convenient indicators to predict renal involvement in HSP patients with infection. METHOD We conducted a retrospective study of 208 HSP children and 98 healthy children. Clinical parameters were compared in those cases. RESULTS A total of 68.75% of patients were infected with various pathogens. The mean platelet volume (MPV) (P < 0.02) was lower in HSP patients with infection than patients without infection. Mycoplasma pneumoniae (MP) infection accounted for the largest proportion (45.77%). MPV in HSP nephritis (HSPN) group was lower than in HSP patients (excluded renal involvement) in patients with MP infection. Logistic regression analysis found that age and MPV were risk factors for the occurrence of MP-infected HSPN. The receiver operating characteristic curve (ROC) analysis showed that the combination of MPV with the onset age at the optimal cut-off point had 81% sensitivity in predicting whether HSP patients with MP infection would develop into HSPN. CONCLUSIONS Our research revealed that MP was the most commonly infected pathogen of children's HSP. MPV was an essential predictor of nephritis in HSP patients with MP infection. This discovery can prompt clinical treatments as well as reduce costs. Key Points • Mycoplasma pneumoniae (MP) accounts for the largest proportion in HSP children with infection. • MPV can be used as a predictor for the development of MP-triggered HSP to HSPN.
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Affiliation(s)
- Can Liu
- Clinical Laboratory, Hunan Children's Hospital, Changsha, 410007, China.
| | - Lingli Luo
- Clinical Laboratory, Hunan Children's Hospital, Changsha, 410007, China
| | - Min Fu
- Clinical Laboratory, Hunan Children's Hospital, Changsha, 410007, China
| | - Zhengqiu Li
- Clinical Laboratory, Hunan Children's Hospital, Changsha, 410007, China
| | - Jianlong Liu
- Clinical Laboratory, Hunan Children's Hospital, Changsha, 410007, China
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Comparison of clinical, pathological and long-term renal outcomes of children with Henoch-Schonlein purpura nephritis and IgA nephropathy. Int Urol Nephrol 2021; 54:1925-1932. [PMID: 34846620 DOI: 10.1007/s11255-021-03063-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 11/11/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE To compare clinical, pathological, and long-term renal outcomes of children with Henoch-Schonlein purpura nephritis (HSPN) and IgA nephropathy (IgAN). METHODS The medical records of patients diagnosed as HSPN and IgAN during childhood were evaluated retrospectively. HSPN and IgAN groups were compared in terms of gender, age, upper respiratory infection history, blood pressure; presence of nephrotic and/or nephritic syndrome; hemoglobin level, leukocyte count, C-reactive protein (CRP), serum albumin (sAlb), creatinine, complement 3 (sC3), complement 4 (sC4) and immunoglobulin A (sIgA) levels; estimated glomerular filtration rate (eGFR) and proteinuria levels; and renal pathology findings at the onset of disease; total follow-up time; and blood pressure, eGFR and proteinuria levels at the last visit. RESULTS Fifty-four patients were enrolled in the study [38 (70%) HSPN and 16 (30%) IgAN]. The median follow-up time was 60.5 and 72.0 months in HSPN and IgAN groups, respectively (p > 0.05). The HSPN and IgAN groups were also not different in terms of gender, age at the onset; leukocyte count, eGFR, sC3-sC4-sIgA levels; and the presence of endocapillary, extracapillary and mesangial proliferation, tubular atrophy, interstitial fibrosis and IgA, IgM, C3 accumulation in renal tissue. Upper respiratory tract infection history was more common in children with IgAN (8/16 vs 8/38, p = 0.045). sAlb (3.96 ± 0.58 vs 4.40 ± 0.46 g/dL, p = 0.005), hemoglobin (12.1 ± 1.3 vs 13.3 ± 1.2 g/dL, p = 0.004,) and the incidence of mesangial IgG deposition (15/38 vs 11/16, p = 0.049) were lower, while CRP (16.3 ± 7.2 vs 7.8 ± 4.4 mg/L, p = 0.002) and proteinuria (72.1 ± 92.4 vs 34.2 ± 37.9 mg/m2/24 h, p = 0.041) was higher in HSPN group at the onset of disease. Proteinuria and eGFR were similar between the two groups at last visit. CONCLUSION Children with HSPN and IgAN have little clinical and histological differences in our population. The most prominent difference at presentation with nephritis was higher proteinuria in HSPN probably associated with inflammation due to systemic vasculitis. Long-term renal outcome was good in both HSPN and IgAN.
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Cao J, Wu C, Wang K, Hu H, Duan J, Zhao B, Xiong J, Liu M, Cui J, Ji X, Zhang T, Qin H, Qin N, Xu Q, Huang Y. Metagenomic profiling reveals dominance of gram-positive bacteria in the gut microbiome shifts associated with immunoglobulin A vasculitis (Henoch-Schönlein Purpura). Clin Transl Immunology 2021; 10:e1342. [PMID: 34646556 PMCID: PMC8499602 DOI: 10.1002/cti2.1342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/21/2021] [Accepted: 08/22/2021] [Indexed: 12/24/2022] Open
Abstract
Objectives Immunoglobulin A vasculitis (IgAV), previously known as Henoch-Schönlein purpura, is the most common vasculitis that has a classical skin manifestation of palpable purpuric rash. Factors pertinent to IgAV remain inadequately understood. Here, we aimed to examine the gut microbiome shifts associated with IgAV and its recovery. Methods Stool samples were collected from 10 children with IgAV (6-14 years old) before and after a multi-drug therapy, along with 9 age-matched healthy children. The samples were subjected to metagenomic analyses to investigate the taxonomic and functional shifts of the gut microbiome. Results The analyses revealed that compared with healthy controls, treatment-naïve patients exhibited substantial taxonomic and functional alterations of gut microbiota, including 104 IgAV-depleted species and 7 IgAV-elevated species (FDR < 0.05). After treatment, the IgAV patients displayed a partial restoration of the microbiota shifts, as the relative abundances of some biomarkers (e.g. 9 genera and 22 species) became comparable (FDR > 0.1) between the patients and healthy controls. The treatment-responsive features included Weissella, Faecalibacterium prausnitzii and Bifidobacterium pseudocatenulatum and three components of a putative glutamine transport system. Importantly, gram-positive bacteria accounted for over 85% of the numbers and total relative abundance of the species that were associated with IgAV and responsive to the treatment. In addition, of the 122 IgAV-depleted bacterial genes, 82 were mainly contributed by gram-positive bacteria and 12 by gram-negative bacteria. Conclusions Gram-positive bacteria are the main drivers underlying the gut microbiome shifts of IgAV, which may assist rational management of the disease.
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Affiliation(s)
- Jia Cao
- Department of Pediatrics The First Affiliated Hospital of Kunming Medical University Kunming China.,Yunnan Key Laboratory of Clinical Medicine Kunming China
| | - Chunyan Wu
- Shanghai Tenth People's Hospital Tongji University School of Medicine Shanghai China.,Realbio Genomics Institute Shanghai China
| | - Kunhua Wang
- Yunnan Key Laboratory of Clinical Medicine Kunming China
| | - Hongwei Hu
- Department of Pediatrics The First Affiliated Hospital of Kunming Medical University Kunming China
| | - Jiang Duan
- Department of Pediatrics The First Affiliated Hospital of Kunming Medical University Kunming China
| | - Bo Zhao
- Department of Rheumatology and Immunology the Affiliated Children's Hospital of Kunming Medical University Kunming China
| | - Jingjing Xiong
- Department of Pediatrics The First Affiliated Hospital of Kunming Medical University Kunming China
| | - Mei Liu
- Department of Pediatrics The First Affiliated Hospital of Kunming Medical University Kunming China
| | - Jingjing Cui
- Department of Rheumatology and Immunology the Affiliated Children's Hospital of Kunming Medical University Kunming China
| | - Xiaofei Ji
- Department of Pediatrics The First Affiliated Hospital of Kunming Medical University Kunming China
| | - Tingting Zhang
- Department of Pediatrics The First Affiliated Hospital of Kunming Medical University Kunming China
| | - Huanlong Qin
- Shanghai Tenth People's Hospital Tongji University School of Medicine Shanghai China
| | - Nan Qin
- Shanghai Tenth People's Hospital Tongji University School of Medicine Shanghai China.,Realbio Genomics Institute Shanghai China
| | - Qian Xu
- Shanghai Tenth People's Hospital Tongji University School of Medicine Shanghai China.,Realbio Genomics Institute Shanghai China
| | - Yongkun Huang
- Department of Pediatrics The First Affiliated Hospital of Kunming Medical University Kunming China.,Yunnan Key Laboratory of Clinical Medicine Kunming China
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Gastrointestinal involvement in IgA vasculitis: a single-center 11-year study on a cohort of 118 children. Clin Rheumatol 2021; 40:5041-5046. [PMID: 34273001 DOI: 10.1007/s10067-021-05863-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES Immunoglobulin A vasculitis (IgAV), the most common childhood vasculitis, is associated with gastrointestinal (GI) involvement in 50-75% of cases. The aim of this study was to describe the characteristics of GI involvement in a cohort of hospitalized children with IgAV. METHODS We retrospectively evaluated patients hospitalized for IgAV at Meyer Children's University Hospital, from January 2010 to December 2020. The children's families were interviewed by phone and asked about disease relapses. RESULTS In the study period, 118 children had GI involvement, corresponding to 75% of children hospitalized for IgAV. Their median age was 7 years (interquartile range 6-9). The most frequent GI manifestations were abdominal pain (96%), bleeding (71%, mostly occult), vomiting (58%), and diarrhea (17%). GI complications, observed in 18%, were intussusception (14%), appendicitis (3%), gallbladder hydrops (2%), and ileal perforation (1%). Abdomen ultrasound, performed in all cases, was abnormal in 68%. Abdomen X-ray, performed in 19 patients, showed pathologic findings in 84% of them. Selected children with severe manifestations also underwent abdomen computed tomography (2/118; 2%) and GI endoscopy (5/118; 4%). Steroids were used in 80 (67.8%) cases. The use of second- and third-line therapies was necessary in three cases. Relapses, investigated in 80 cases (68%), occurred in 21% of them. Key Points • The present retrospective study describes a cohort of 118 patients hospitalized for gastrointestinal (GI) involvement in immunoglobulin A vasculitis (IgAV) at a tertiary care children's hospital from January 2010 to December 2020. • The most frequent GI manifestations were abdominal pain (96%), vomiting (58%), and diarrhea (17%). GI bleeding was reported in 71% of children, and it was occult in most cases. • GI complications, occurring in 18% of cases, were intussusception (14%), appendicitis (3%), gallbladder hydrops (2%), and ileal perforation (1%). • Steroid treatment has been successfully used in severe GI manifestations; however, our data do not support its association with low relapse risk. CONCLUSIONS The present study describes a large pediatric cohort of GI involvement in IgAV. Steroid treatment should be used when GI manifestations are severe. The association of steroid use with relapse risk is not currently established.
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Liao CH, Tsai M, Yang YH, Chiang BL, Wang LC. Onset age is a risk factor for refractory pediatric IgA vasculitis: a retrospective cohort study. Pediatr Rheumatol Online J 2020; 18:86. [PMID: 33172497 PMCID: PMC7654143 DOI: 10.1186/s12969-020-00480-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 11/01/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Though outcome differences between children and adults with immunoglobulin A vasculitis (IgAV) has been well documented, it remains unclear if disease features in pediatric IgAV patients vary with onset age. We aimed to explore clinical features and prognosis of pediatric IgAV stratified by onset age. METHODS We retrospectively reviewed records of patients under 18 years old diagnosed with IgAV from January 1999 to December 2018 in one tertiary medical center in Taiwan. Patients were grouped by onset age: ≤ 6 years old, 6-12 years old (> 6, ≤ 12), and 12-18 years old (> 12, < 18). Demographics, laboratory data, incidence of gastrointestinal, renal, and joint involvement, corticosteroid dependence, recurrence, and refractory disease were analyzed. Recurrence was defined as disease flare-up after complete remission and discontinuation of all medications for at least 3 months. Corticosteroid dependence was defined by more than 6 weeks of daily oral corticosteroid intake. Refractory disease was defined as not achieving complete remission 6 months after disease onset. Statistical analysis was performed using R software (v3.6.0). RESULTS There were 484 IgAV patients, with an onset age of 6.10 (4.72-8.58) (median (IQR)) years old. There were 234 (48.3%) patients ≤6 years old, 210 (43.4%) 6-12 years old, and 40 (8.3%) 12-18 years old. One hundred and thirty (26.9%) patients had renal involvement, which was more frequent in older children (≤ 6 years old, 18.4%; 6-12 years old, 31.0%; 12-18 years old, 55.0%; p < 0.001). There were 361 patients (74.6%) with joint involvement; younger children were affected more frequently (≤ 6 years old, 82.1%; 6-12 years old, 71.9%; 12-18 years old, 45.0%; p < 0.001). Gastrointestinal involvement was present in 311 (64.3%) patients, showing no difference among age groups. There were 46 patients (9.5%) with recurrent IgA vasculitis, 136 (28.1%) with corticosteroid dependent and 76 (15.7%) with refractory disease. Corticosteroid dependence and refractory disease occurred more frequently as onset age increased (p < 0.001). CONCLUSION Pediatric IgAV with different onset ages are associated with distinct clinical manifestations and outcomes. The risk of developing corticosteroid dependence, refractory disease and renal involvement increased with onset age.
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Affiliation(s)
- Chun-Hua Liao
- grid.412094.a0000 0004 0572 7815Department of Pediatrics, National Taiwan University Hospital, No.8, Chung Shan South Road, Taipei, 10002 Taiwan
| | - Melody Tsai
- grid.412094.a0000 0004 0572 7815Department of Pediatrics, National Taiwan University Hospital, No.8, Chung Shan South Road, Taipei, 10002 Taiwan
| | - Yao-Hsu Yang
- grid.412094.a0000 0004 0572 7815Department of Pediatrics, National Taiwan University Hospital, No.8, Chung Shan South Road, Taipei, 10002 Taiwan
| | - Bor-Luen Chiang
- grid.412094.a0000 0004 0572 7815Department of Pediatrics, National Taiwan University Hospital, No.8, Chung Shan South Road, Taipei, 10002 Taiwan ,grid.412094.a0000 0004 0572 7815Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Chieh Wang
- Department of Pediatrics, National Taiwan University Hospital, No.8, Chung Shan South Road, Taipei, 10002, Taiwan.
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Al E'ed A. Henoch-Schönlein purpura in Saudi Arabia: characteristics and rare vital organ involvement. Minerva Pediatr (Torino) 2020; 73:363-370. [PMID: 32960004 DOI: 10.23736/s2724-5276.20.05962-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Henoch-Schönlein purpura (HSP) is the most common small vessel vasculitis in children with an annual incidence of between 10 and 30 per 100,000. It is an inflammation that affects many organs primarily in the skin, gastrointestinal (GI) tract, musculoskeletal, also vital organs like kidneys and lungs which may lead to chronic kidney disease and pulmonary hemorrhage. In this review, we are showing the characteristics of Saudi patients with HSP and the relation with preceding infections, gender, and seasonal variations in addition to the common and most severe systemic involvements. We found cases that were challenging to diagnose and others with unfortunate fetal complications.
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Affiliation(s)
- Ashwaq Al E'ed
- Department of Pediatrics, College of Medicine, Qassim University, Qassim, Saudi Arabia -
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10
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Koskela M, Jahnukainen T, Endén K, Arikoski P, Kataja J, Nuutinen M, Ylinen E. Methylprednisolone or cyclosporine a in the treatment of Henoch-Schönlein nephritis: a nationwide study. Pediatr Nephrol 2019; 34:1447-1456. [PMID: 30955086 DOI: 10.1007/s00467-019-04238-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/10/2019] [Accepted: 03/14/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Optimal treatment of Henoch-Schönlein purpura nephritis (HSN) remains unclear. We evaluated outcome of pediatric HSN patients treated initially with either methylprednisolone (MP) or cyclosporine A (CyA) in Finland between 1996 and 2011. METHODS Outcome of 62 HSN patients was evaluated by screening urine and blood samples (n = 51) or by collecting clinical parameters from medical charts until last follow-up visit (n = 11). Sixty (97%) patients had nephrotic-range proteinuria and/or ISKDC grade ≥ III before initial treatment. Patients were initially treated with either MP pulses (n = 42) followed by oral prednisone or with CyA (n = 20). Fifty-nine (95%) patients received angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers. RESULTS Mean follow-up time was 10.8 years (range 3.2-21.2 years). One patient developed end-stage renal disease and another had decreased renal function (eGFR < 60 mL/min/1.73m2), both initially treated with MP (3%). Six patients (5 MP, 1 CyA) had eGFR between 60 and 89 mL/min/1.73m2 (10%). Eighteen patients (13 MP, 5 CyA) had proteinuria and/or hematuria (29%) and four of them had proteinuria > 0.5 g/day at end of follow-up. Sixteen (38%) MP-treated and two (10%) CyA-treated patients needed additional immunosuppressive treatment (RR 3.81, 95% CI 1.16-14.3, p = 0.035). Late initiation of treatment was associated with an increased risk for persistent proteinuria. CONCLUSIONS Long-term outcome was relatively good in both treatment groups. However, since urinary abnormalities may persist or develop, long-term follow-up of HSN patients is mandatory. Early initiation of treatment had a favorable effect on proteinuria.
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Affiliation(s)
- Mikael Koskela
- Children's Hospital, Pediatric Research Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland. .,Department of Pediatric Nephrology and Transplantation, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, 00290, Helsinki, Finland.
| | - Timo Jahnukainen
- Department of Pediatric Nephrology and Transplantation, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, 00290, Helsinki, Finland
| | - Kira Endén
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
| | - Pekka Arikoski
- Department of Pediatrics, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Janne Kataja
- Pediatric and Adolescent Medicine, Turku University Hospital, Turku, Finland
| | - Matti Nuutinen
- Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit, Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Medical Research Center Oulu (MRC Oulu), Oulu, Finland
| | - Elisa Ylinen
- Department of Pediatric Nephrology and Transplantation, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, 00290, Helsinki, Finland
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Changes in clinical features in Henoch-Schönlein purpura during three decades: an observational study at a single hospital in Korea. Clin Rheumatol 2019; 38:2811-2818. [PMID: 31209707 DOI: 10.1007/s10067-019-04628-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/22/2019] [Accepted: 05/28/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE It is unknown whether epidemiological or clinical characteristics of Henoch-Schönlein purpura (HSP) have changed over time. This study aimed at evaluating the epidemiological and clinical changes of HSP during 3 decades. METHODS We retrospectively analyzed the data of 515 children with HSP (0-15 years of age) between 1987 and 2015. We compared the two HSP patient groups: those admitted from 1987 to 1996 (group A, 238 cases) and those admitted from 2006 to 2015 (group B, 98 cases), apart a decade. RESULTS In total 515 patients, the mean age was 6.5 ± 3.0 years and the male-to-female ratio was 1.2:1 (278:237). The age distribution showed a peak at age 5 with a bell-shaped distribution pattern. The annual number of cases varied in each year with a trend of reduced cases in the recent decade. There were less cases during the summer season. Purpura, gastrointestinal involvement, joint involvement, and renal involvement were found in 100%, 56%, 38%, and 18% of the patients, respectively. In comparison between the two groups, there were similar findings in mean age, age distribution, and seasonal distribution. However, the hospitalization stay was longer, and the proportion of recurrent cases (14 cases vs. 0 case) and proteinuria (15% vs. 3%) were higher in the group A than in the group B. CONCLUSIONS Long-term epidemiologic features of HSP were similar to those in other countries. Clinical manifestations of HSP showed a trend towards a less severe clinical phenotype over time in Deajeon, Korea. Key Points • It is unknown whether epidemiological and clinical traits of Henoch-Schönlein purpura (HSP) have changed over time. • We reported that clinical manifestations of HSP have changed to milder phenotype through a long-term observation of three decades at a single hospital in Daejeon, South Korea. • Clinical phenotype of infection-related diseases, including HSP, may be changed over time, and the etiology and the reason of clinical changes over time remain to be solved.
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Çakıcı EK, Gür G, Yazılıtaş F, Eroğlu FK, Güngör T, Arda N, Orhan D, Özalp Ateş FS, Bülbül M. A retrospective analysis of children with Henoch–Schonlein purpura and re-evaluation of renal pathologies using Oxford classification. Clin Exp Nephrol 2019; 23:939-947. [DOI: 10.1007/s10157-019-01726-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 03/10/2019] [Indexed: 10/27/2022]
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The clinical spectrum of Henoch-Schönlein purpura in children: a single-center study. Clin Rheumatol 2019; 38:1707-1714. [PMID: 30734116 DOI: 10.1007/s10067-019-04460-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 01/25/2019] [Accepted: 01/28/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Henoch-Schönlein purpura (HSP) is the most common vasculitis of children. The aim of this study is to evaluate the demographic and clinic findings of patients with HSP and also to determine predictive factors for assessing the development of gastrointestinal system (GIS) and renal involvement. METHODS This study was performed prospectively among children with HSP who are under 18 years of age and being followed-up in the Pediatric Rheumatology Unit of Health Sciences University Kanuni Sultan Süleyman Training and Research Hospital between January 2016 and January 2018. RESULTS A total of 265 patients, 137 boys (51.7%) and 128 girls (48.3%), were involved to the study. The mean ± standard deviation of age at the diagnosis was 7.5 ± 3.2. The most common disease onset season was spring (31.7%). The rate of arthritis, GIS involvement, and renal involvement were 54%, 51.3%, and 29.1%, respectively. GIS bleeding was more frequent in males than females (p = 0.007). Boys over 7 years of age had significantly more common GIS bleeding (p = 0.04). Intussusception, relapse, and serious GIS involvement requiring hospitalization and steroid treatment were highly associated with severe renal involvement. CONCLUSIONS We demonstrated that patients suffering intussusception, relapse, and serious GIS involvement or requiring hospitalization and steroid treatment had tendency to present with severe renal involvement. Therefore, these patients should be followed up carefully for not overlooking renal involvement of HSP.
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Miray Kisla Ekinci R, Balci S, Serbes M, Duyuler Ayçin G, Dogruel D, Ufuk Altintas D, Yilmaz M. Recurrent Henoch Schönlein purpura without renal involvement successfully treated with methotrexate. Scott Med J 2018; 64:74-77. [DOI: 10.1177/0036933018809816] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Henoch Schönlein purpura is characterised by palpable purpura, abdominal pain, arthritis/arthralgia, often with a self-limiting course. Herein, we report a patient with recurrent Henoch Schönlein purpura and severe gastrointestinal involvement, successfully treated with methotrexate. Case presentation A 12-year-old boy was admitted to our department with palpable purpura, abdominal pain and arthralgia. Since gastrointestinal complaints were severe, systemic steroids were administered, with tapering of dosage. Henoch Schönlein purpura recurred several times with severe abdominal pain, maelena and purpura during next two months. Colchicine and hydroxychloroquine were initiated. After four months, we also introduced methotrexate, which enabled discontinuation of previous medications including corticosteroids. Methotrexate was ceased four months later, and remission was sustained without any medications for 24 months. Conclusion Besides the conflicting data regarding the use of methotrexate in recurrent Henoch Schönlein purpura, our case introduces successful methotrexate experience in a child with Henoch Schönlein purpura and recurrent severe gastrointestinal involvement.
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Affiliation(s)
| | - Sibel Balci
- MD, Department of Pediatric Rheumatology, Cukurova University Faculty of Medicine, Turkey
| | - Mahir Serbes
- MD, Department of Pediatric Allergy and Immunology, Cukurova University Faculty of Medicine, Turkey
| | - Gulsah Duyuler Ayçin
- MD, Department of Pediatric Allergy and Immunology, Cukurova University Faculty of Medicine, Turkey
| | - Dilek Dogruel
- Associate Professor, Department of Pediatric Allergy and Immunology, Cukurova University Faculty of Medicine, Turkey
| | - Derya Ufuk Altintas
- Professor, Department of Pediatric Allergy and Immunology, Cukurova University Faculty of Medicine, Turkey
| | - Mustafa Yilmaz
- Professor, Department of Pediatric Rheumatology, Cukurova University Faculty of Medicine, Turkey
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Lei WT, Tsai PL, Chu SH, Kao YH, Lin CY, Fang LC, Shyur SD, Lin YW, Wu SI. Incidence and risk factors for recurrent Henoch-Schönlein purpura in children from a 16-year nationwide database. Pediatr Rheumatol Online J 2018; 16:25. [PMID: 29661187 PMCID: PMC5902957 DOI: 10.1186/s12969-018-0247-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 04/11/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The recurrence rate of Henoch-Schönlein purpura (HSP) is 2.7%-30%, with varied average intervals between the first and second episodes. Few studies have explored the incidence and risk factors for recurrent HSP. METHODS We used a 16-year nationwide database to analyze the incidence of recurrent HSP. Patients with HSP were identified, and risk factors for recurrent HSP were explored. Kaplan-Meier and Cox regression model analyses were performed, and covariates were adjusted in the multivariate model. RESULTS From January 1, 1997 to December 31, 2012, among 2,886,836 individuals in the National Health Insurance Research Database, 1002 HSP patients aged < 18 years were identified. Among them, 164 had ≥2 HSP episodes (recurrence rate, 16.4%; incidence of recurrent HSP, 7.05 per 100 person-years); 83.6% patients with one HSP episode remained free of secondary HSP. The average time intervals between the first and second and second and third HSP episodes were 9.2 and 6.4 months, respectively. After adjusting for demographic parameters, comorbidities, and socioeconomic status, recurrent HSP was found to occur more frequently in patients who had renal involvement (adjusted hazard ratio, 2.41; 95% confidence interval [CI], 1.64-3.54; p < 0.001), were receiving steroid therapy for > 10 days (adjusted hazard ratio, 8.13; 95%CI, 2.51-26.36; p < 0.001), and had allergic rhinitis (adjusted hazard ratio, 1.63; 95%CI, 1.06-2.50; p = 0.026). CONCLUSIONS The annual incidence of recurrent HSP was low. However, children who had underlying allergic rhinitis, presented with renal involvement, and received steroid treatment for > 10 days should be notified regarding the possibility of recurrence.
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Affiliation(s)
- Wei-Te Lei
- 0000 0004 0573 007Xgrid.413593.9Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Po-Li Tsai
- Division of Colorectal Surgery, Department of Surgery, Mackey Memorial Hospital, Taipei, Taiwan
| | - Szu-Hung Chu
- 0000 0004 0573 007Xgrid.413593.9Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Yu-Hsuan Kao
- 0000 0004 0573 007Xgrid.413593.9Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Chien-Yu Lin
- 0000 0004 0573 007Xgrid.413593.9Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Li-Ching Fang
- 0000 0004 0573 007Xgrid.413593.9Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Shyh-Dar Shyur
- 0000 0004 0573 007Xgrid.413593.9Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Yu-Wen Lin
- 0000 0004 0573 007Xgrid.413593.9Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shu-I Wu
- Department of Medicine, Mackay Medical College, No.45, Minsheng Rd., Tamsui Dist., New Taipei City, 25160, Taiwan. .,Audiology and Speech Language Pathology, Mackay Medical College, No.45, Minsheng Rd., Tamsui Dist., New Taipei City, 25160, Taiwan. .,Department of Psychiatry, Mackay Memorial Hospital, No.45, Minsheng Rd., Tamsui Dist., New Taipei City, 25160, Taiwan.
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Yamane K, Kawasaki Y, Maeda R, Ohara S, Suyama K, Hosoya M. The incidence and severity of IgA vasculitis with nephritis over a 10-year period in our hospital. Fukushima J Med Sci 2017; 63:135-140. [PMID: 28904302 DOI: 10.5387/fms.2017-14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To evaluate the recent frequency of onset and severity of IgA vasculitis with nephritis (IgAVN) in Fukushima Prefecture, we examined the epidemiology and clinico-pathological manifestations of IgAVN in our hospital over a 10-year period. METHODS We enrolled 18 patients with IgAVN treated between 2004 and 2013 in the Department of Pediatrics, Fukushima Medical University School of Medicine. These patients were divided into two groups; Group 1 consisted of 12 patients with IgAVN hospitalized between 2004 and 2008 and Group 2 consisted of 6 patients with IgAVN hospitalized between 2009 and 2013. The epidemiology, clinical features, laboratory data, pathological findings, and outcome were retrospectively compared between the two groups. RESULTS The numbers of patients with IgAVN per year in Group 2 were lower than that in Group 1. The frequency of patients with higher than grade IIIb disease in Group 2 (50%) was lower than that in Group 1 (94%); furthermore, the frequency of patients with higher than grade IV disease in Group 2 (0%) was lower than that in Group 1 (50%). CONCLUSIONS Our findings suggest that the incidence of onset and severity of IgAVN in patients diagnosed between 2009 and 2013 were lower than those in patients diagnosed between 2004 and 2008.
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Affiliation(s)
- Keishi Yamane
- Department of Pediatrics, Fukushima Medical University School of Medicine
| | - Yukihiko Kawasaki
- Department of Pediatrics, Fukushima Medical University School of Medicine
| | - Ryo Maeda
- Department of Pediatrics, Fukushima Medical University School of Medicine
| | - Shinichiro Ohara
- Department of Pediatrics, Fukushima Medical University School of Medicine
| | - Kazuhide Suyama
- Department of Pediatrics, Fukushima Medical University School of Medicine
| | - Mitsuaki Hosoya
- Department of Pediatrics, Fukushima Medical University School of Medicine
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Demographic characteristics, aetiology, and assessment of treatment options in leukocytoclastic vasculitis. Postepy Dermatol Alergol 2017; 34:104-109. [PMID: 28507487 PMCID: PMC5420600 DOI: 10.5114/ada.2017.67071] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 03/03/2016] [Indexed: 01/10/2023] Open
Abstract
Introduction Vasculitides are a heterogeneous group of diseases characterized by inflammation of the blood vessel walls. Etiological factors include infections, drugs, connective tissue diseases, and malignancies. Aim To examine the demographic characteristics, etiological factors, and treatment options in 75 patients with leukocytoclastic vasculitis. Material and methods The study included 75 patients diagnosed with leukocytoclastic vasculitis at our clinic. The patients’ medical records were reviewed to determine their age, sex, presence of systemic symptoms, possible etiological factors, laboratory results, types of cutaneous lesions, locations of the lesions, treatment options, and disease course. Results There were 43 women and 32 men. Cutaneous lesions affected only the lower limbs in 60 of the 75 patients (80%) and usually presented as palpable purpura (64%, n = 48). Arthralgia (26.7%, n = 20) was the most frequent extracutaneous symptom. Of the patients with secondary vasculitis, the most common causes were infections and drugs. The mean age of the patients with Henoch-Schönlein purpura was 26.8 years. There was no significant association between age and renal, gastrointestinal, or joint involvement. Conclusions The most common form of vasculitis in our study was cutaneous leukocytoclastic vasculitis. In most of the patients it appeared to be idiopathic. Among drugs, antibiotics were the most common etiological factor. In 4 patients, the cutaneous leukocytoclastic vasculitis behaved like the paraneoplastic syndrome.
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Chan H, Tang YL, Lv XH, Zhang GF, Wang M, Yang HP, Li Q. Risk Factors Associated with Renal Involvement in Childhood Henoch-Schönlein Purpura: A Meta-Analysis. PLoS One 2016; 11:e0167346. [PMID: 27902749 PMCID: PMC5130272 DOI: 10.1371/journal.pone.0167346] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 11/12/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Henoch-Schönlein purpura (HSP) is an important cause of chronic kidney disease in children. This meta-analysis identified risk factors associated with renal involvement in childhood HSP. METHODS PubMed, Embase, and Web of Science were searched. The quality of all eligible studies was assessed using the Newcastle-Ottawa scale criteria. An analysis of possible risk factors was conducted to report the odds ratio (OR) and weighted mean difference (WMD). RESULTS Thirteen studies (2398 children) revealed 20 possible and 13 significant risk factors associated with renal involvement in HSP, with the following meta-analysis estimates of OR and WMD, with 95% confidence intervals: older age (0.90, 0.61-1.19); age > 10 y (3.13, 1.39-7.07); male gender (1.36, 1.07-1.74); abdominal pain (1.94,1.24-3.04); gastrointestinal bleeding (1.86, 1.30-2.65); severe bowel angina (3.38, 1.17-9.80); persistent purpura (4.02, 1.22-13.25); relapse (4.70, 2.42-9.14); WBC > 15 × 109/L (2.42, 1.39-4.22); platelets > 500 × 109/L (2.98, 1.22-7.25); elevated antistreptolysin O (ASO) (2.17, 1.29-3.64); and decreased complement component 3 (C3) (3.13, 1.62-6.05). Factors not significantly associated with renal involvement were: blood pressure; orchitis; elevated C-reactive protein; elevated erythrocyte sedimentation rate (ESR); and elevated serum IgA/IgE or IgG. Arthritis/arthralgia may be a risk factor according to the criteria of the American College of Rheumatology (1.41, 1.01-1.96). CONCLUSION The following are associated with renal involvement in pediatric HSP: male gender; > 10 y old; severe gastrointestinal symptoms (abdominal pain, gastrointestinal bleeding, and severe bowel angina); arthritis/arthralgia; persistent purpura or relapse; WBC > 15 × 109/L; platelets > 500 × 109/L; elevated ASO; and low C3. Relevant clinical interventions for these risk factors may exert positive effects on the prevention of kidney disease during the early stages of HSP. However, the results should be interpreted cautiously due to the limitations of the studies.
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Affiliation(s)
- Han Chan
- Department of Nephrology, Key Laboratory of the Ministry of Education, Children’s Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Yan-Ling Tang
- Department of Nephrology, Key Laboratory of the Ministry of Education, Children’s Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Xiao-Hang Lv
- Department of Nephrology, Key Laboratory of the Ministry of Education, Children’s Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Gao-Fu Zhang
- Department of Nephrology, Key Laboratory of the Ministry of Education, Children’s Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Mo Wang
- Department of Nephrology, Key Laboratory of the Ministry of Education, Children’s Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Hai-Ping Yang
- Department of Nephrology, Key Laboratory of the Ministry of Education, Children’s Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Qiu Li
- Department of Nephrology, Key Laboratory of the Ministry of Education, Children’s Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
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Liu Z, Wei YD, Hou Y, Xu Y, Li XJ, Du YJ. Differences in pathological characteristics and laboratory indicators in adult and pediatric patients with Henoch-Schönlein purpura nephritis. ACTA ACUST UNITED AC 2016; 36:659-666. [DOI: 10.1007/s11596-016-1642-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 05/04/2016] [Indexed: 10/20/2022]
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Mooij CF, Hermsen R, Hoppenreijs EPAH, Bleeker-Rovers CP, IJland MM, de Geus-Oei LF. Fludeoxyglucose positron emission tomography-computed tomography scan showing polyarthritis in a patient with an atypical presentation of Henoch-Schönlein vasculitis without clinical signs of arthritis: a case report. J Med Case Rep 2016; 10:159. [PMID: 27255933 PMCID: PMC4890487 DOI: 10.1186/s13256-016-0913-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 04/25/2016] [Indexed: 01/14/2023] Open
Abstract
Background Henoch-Schönlein vasculitis is the most common systemic vasculitis in children. Arthritis or arthralgia occurs in 80 % of patients. We believe this to be the first case report to describe the finding of polyarthritis in a fludeoxyglucose positron emission tomography-computed tomography scan in a patient with Henoch-Schönlein vasculitis without clinical signs of arthritis. Case presentation A 4.5-year-old Caucasian boy presented with fever of 4 days’ duration followed by debilitating migratory arthralgia and inflammation. He underwent a fludeoxyglucose positron emission tomography-computed tomography scan to exclude a possible malignant cause or to detect any infectious or autoimmune focus of his symptoms. Fludeoxyglucose uptake was observed in multiple large joints and in multiple tendons. These findings suggested active polyarthritis and polytendinitis. However, physical and ultrasound evaluations did not show any signs of arthritis in our patient, despite his evident arthralgia. Conclusions Fludeoxyglucose positron emission tomography-computed tomography might be able to detect inflammatory activity in painful joints that cannot yet be detected clinically or with ultrasound evaluation in a patient with Henoch-Schönlein vasculitis. Therefore, fludeoxyglucose positron emission tomography-computed tomography can be of additional value in the diagnostic workup of patients with an unresolved diagnosis of suspected autoimmune disease, especially in patients with unresolved arthralgia and fever of unknown cause.
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Affiliation(s)
- Christiaan F Mooij
- Department of Pediatrics, Amalia Children's Hospital, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Rick Hermsen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Esther P A H Hoppenreijs
- Department of Pediatric Rheumatology, Amalia Children's Hospital, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Chantal P Bleeker-Rovers
- Department of Internal Medicine, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Marloes M IJland
- Department of Pediatrics, Amalia Children's Hospital, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
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Li Y, Feng X, Huang L, Zhu H, Xu Y, Sui X, Xu Y, Han Y, Qin C. Hematologic and immunological characteristics of Henoch-Schönlein purpura in rat and rabbit models induced with ovalbumin based on type III hypersensitivity. Sci Rep 2015; 5:8862. [PMID: 25749457 PMCID: PMC4352856 DOI: 10.1038/srep08862] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 02/05/2015] [Indexed: 11/16/2022] Open
Abstract
Henoch-Schönlein purpura (HSP) is a common systemic vasculitis in children. Animal models of HSP are needed to better understand the mechanism of HSP. Here, we investigated hematologic and immunologic profiles in HSP rat and rabbit models. Models were established with ovalbumin (OVA) based on type III hypersensitivity. During the acute phase, the models exhibited varying degrees of cutaneous purpura, joint inflammatory response, gastrointestinal bleeding, glomerular capsule protein exudation, vascular dilatation, and increased IgA expression and immune complex deposition. Twenty four hours after antigen challenge, compared with the controls, the models showed a significantly increased white blood cell count and granulocytes count and percentage, decreased number and percentage of lymphocytes, no change in platelet concentration, significantly increased serum IL-4 and TNF-α levels, and decreased CD4+ T cell, CD4/CD8 ratio, and C3 and C4 levels. Compared with the hematologic and immunologic profiles in pediatric HSP patients, the rat and rabbit HSP models can mimic pediatric HSP characteristics. Our studies provide two useful animal models for further investigations of the pathogenesis, diagnosis, drug screening and treatment of HSP.
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Affiliation(s)
- Yanhong Li
- Key Laboratory of Human Disease Comparative Medicine, Ministry of Health, Institute of Medical Laboratory Animal Science, Chinese Academy of Medical Sciences; Key Laboratory of Human Disease Animal Models, State Administration of Traditional Chinese Medicine, Peking Union Medicine College, Beijing 100021, China
| | - Xiaochun Feng
- Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun 130021
| | - Lan Huang
- Key Laboratory of Human Disease Comparative Medicine, Ministry of Health, Institute of Medical Laboratory Animal Science, Chinese Academy of Medical Sciences; Key Laboratory of Human Disease Animal Models, State Administration of Traditional Chinese Medicine, Peking Union Medicine College, Beijing 100021, China
| | - Hua Zhu
- Key Laboratory of Human Disease Comparative Medicine, Ministry of Health, Institute of Medical Laboratory Animal Science, Chinese Academy of Medical Sciences; Key Laboratory of Human Disease Animal Models, State Administration of Traditional Chinese Medicine, Peking Union Medicine College, Beijing 100021, China
| | - Yanfeng Xu
- Key Laboratory of Human Disease Comparative Medicine, Ministry of Health, Institute of Medical Laboratory Animal Science, Chinese Academy of Medical Sciences; Key Laboratory of Human Disease Animal Models, State Administration of Traditional Chinese Medicine, Peking Union Medicine College, Beijing 100021, China
| | - Xiaolong Sui
- Key Laboratory of Human Disease Comparative Medicine, Ministry of Health, Institute of Medical Laboratory Animal Science, Chinese Academy of Medical Sciences; Key Laboratory of Human Disease Animal Models, State Administration of Traditional Chinese Medicine, Peking Union Medicine College, Beijing 100021, China
| | - Yuhuan Xu
- Key Laboratory of Human Disease Comparative Medicine, Ministry of Health, Institute of Medical Laboratory Animal Science, Chinese Academy of Medical Sciences; Key Laboratory of Human Disease Animal Models, State Administration of Traditional Chinese Medicine, Peking Union Medicine College, Beijing 100021, China
| | - Yunlin Han
- Key Laboratory of Human Disease Comparative Medicine, Ministry of Health, Institute of Medical Laboratory Animal Science, Chinese Academy of Medical Sciences; Key Laboratory of Human Disease Animal Models, State Administration of Traditional Chinese Medicine, Peking Union Medicine College, Beijing 100021, China
| | - Chuan Qin
- Key Laboratory of Human Disease Comparative Medicine, Ministry of Health, Institute of Medical Laboratory Animal Science, Chinese Academy of Medical Sciences; Key Laboratory of Human Disease Animal Models, State Administration of Traditional Chinese Medicine, Peking Union Medicine College, Beijing 100021, China
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Elmas AT, Tabel Y. Platelet Counts in Children With Henoch-Schonlein Purpura--Relationship to Renal Involvement. J Clin Lab Anal 2014; 30:71-4. [PMID: 25385472 DOI: 10.1002/jcla.21817] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 03/17/2014] [Accepted: 08/25/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The aim of this study is to identify the clinical and laboratory risk factors for renal involvement and to determine the relationship between platelet counts and renal involvement in (Henoch-Schönlein purpura) HSP patients. METHODS We reviewed the medical records of 107 children with HSP according to Eular/Press diagnostic criteria. Clinical and laboratory parameters for renal involvement were evaluated and compared to no renal involvement. RESULTS A retrospective study consisted of 107 children, 61 boys (57%), and 46 girls (43%). Twenty-eight of the 107 patients (26.1%) had renal involvement. The mean platelet count was significantly higher in patients with renal involvement when compared to patients without renal involvement (P = 0.001). The multivariate logistic regression analysis identified that age (P = 0.022), sex (P = 0.037), gastrointestinal involvement (P = 0.019), and platelet count (P = 0.019) were significantly associated with the renal involvement of HSP. The platelet count was predictive of renal involvement, which had odds ratio of 1.0, and achieved area under the curve of 0.66 for predicting the renal involvement within the acute stage of HSP (P = 0.009). CONCLUSION Our study indicated that age, sex, gastrointestinal involvement, and platelet count were significant risk factors of renal involvement of HSP.
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Affiliation(s)
- Ahmet Taner Elmas
- Department of Pediatric Nephrology, Faculty of Medicine, University of Inonu, Malatya, Turkey
| | - Yilmaz Tabel
- Department of Pediatric Nephrology, Faculty of Medicine, University of Inonu, Malatya, Turkey
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Outcome of Henoch-Schönlein purpura 8 years after treatment with a placebo or prednisone at disease onset. Pediatr Nephrol 2012; 27:933-9. [PMID: 22311342 DOI: 10.1007/s00467-012-2106-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 12/22/2011] [Accepted: 12/23/2011] [Indexed: 12/21/2022]
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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The incidence and severity of Henoch-Schönlein purpura nephritis over a 22-year period in Fukushima Prefecture, Japan. Int Urol Nephrol 2010; 42:1023-9. [PMID: 20063060 DOI: 10.1007/s11255-009-9701-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Accepted: 12/22/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Recently, there have been a few reports on the decrease in the incidence of severe Henoch-Schönlein purpura nephritis (HSPN) in Japan. To evaluate the incidence and the severity of HSPN, we examined the epidemiology and clinical manifestations of HSPN in Fukushima Prefecture over a 22-year period. METHODS We enrolled 61 patients (Group 1) diagnosed with HSPN between 1987 and 1997 and a further 59 patients (Group 2) diagnosed with HSPN between 1998 and 2008. Epidemiology, clinical features, laboratory data, pathological findings, treatment and outcome were retrospectively compared between the two groups. RESULTS The mean number of patients per 100,000 children per year was 3.5 ± 1.2 in Group 1 and 3.6 ± 0.8 in Group 2. The clinical manifestations and laboratory findings at onset were comparable between Groups 1 and 2. Pathological findings in Group 1 and Group 2 were classified as ISKDC grade IIIa in 16 (26%) and 14 cases (24%), grade IIIb in 26 (43%) and 27 cases (46%), grade IV in 5 (8%) and 6 cases (10%)), grade V in 1 (2%) and 5 cases (8%), and grade VI in 2 (3%) and 2 cases (3%), respectively. There were no inter-group differences in ISKDC classification or rate of crescentic formation. CONCLUSIONS Our findings suggest that the incidence of HSPN and the severity of HSPN in patients between 1987 and 1997 were similar to those in patients between 1998 and 2008 and that the number of patients with severe HSPN has not decreased.
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Abstract
Internal diseases can manifest in a myriad of skin dermatoses ranging from single disorders such as calciphylaxis, cryoglobulinemia, amyopathic dermatomyositis, and Raynaud phenomenon, to spectrum disorders such as the neutrophilic dermatoses and morphea. In this article the underlying causes, triggering events, constitutional symptoms, clinical features and presentations, appearance at various stages, and pathogenesis are described. The course of the diseases and probable healing outcomes are outlined. Finally, examination and diagnostic methods, and therapies and treatments are provided.
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Affiliation(s)
- Andrew G Franks
- Department of Dermatology, New York University School of Medicine, 550 First Avenue, New York, NY 10016, USA.
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