AB1377 FULLY AUTOMATIC ASSESSMENT OF NAIL FOLD CAPILLAROSCOPY SOFTWARE – PILOT STUDY

Background

The nail fold capillaroscopy is one of the basic techniques used in diagnosis and monitoring the course of connective tissue diseases, primarily a systemic sclerosis. However, the assessment of the capillary image is time-consuming and subjective, this makes it difficult for a detailed comparison of studies assessed by various physicians.

Objectives

The aim of this study was to validate an automated software for classification the nail fold capillaroscopy as normal or pathological and counting the numerous of vessels on a millimetre.

Methods

100 correct and 100 pathological images were selected from the capillaroscopic image database. The original examination was performed with Dinolite MEDL4N Pro. The classic, manual evaluation of the capillaroscopy was performed twice. The imagines was classified as correct or pathological and mean number of capillaries per millimetre was calculated. The photos were then exported to the training program created for the study, the region of interest (ROI) and individual capillaries were marked. The calculation of the number of vessels was made at a magnification of about 50x (ensuring the maximum quality of the image obtained during a classic examination). The neural network was trained using the fast.ai library (based on PyTorch). The ResNet-34 deep residual neural network was chosen, 10-fold cross-validation with validation and test set was performed, using Darknet-YoloV3 state of the art neural network in a GPU-optimized (P5000 GPU) environment. For calculation of 1mm capillaries, additional detection mechanism was designed, in order to automatically detect the scale of the image and transform it into proper pixel dimensions.

Results

The results obtained under neural network training have been referred to the results obtained as part of a manual photo assessment. For the image classification correct vs pathological test sensitivity 89.0% and specificity 86.9% was obtained. For validation (20% of images have been drawn as a validating group), 89.0% and 89.4% respectively were noticed. For the average number of capillaries in 1mm, an average of three regions have been estimated (the first region with 1mm from the left, the second with 1mm from the right and the third with 1mm in the middle). The estimated number of capillars in each region has been compared with ground truth data. The RMSE (Root Mean Squared Error) for the test set was 2.81 and the accuracy was 76.2%.

Conclusion

The use of fully automatic Nail Fold Capillaroscopy Software can be a fast and easy method of the correct and changed capillaroscopy pattern classification, the possibility of counting gives a repetitive result regardless of the physician evaluating the capillaroscopy pattern. In the further course of work on the software, it will be possible to distinguish megacapillary, branched vessels, avascularisation and other pathological features, which will allow full automatic image evaluation and easy follow-up of patients.

Disclosure of Interests

None declared

AB0043 THE IMPACT OF ANTI-Ro52 ANTIBODIES ON THE EXPRESSION OF ANTIVIRAL RESPONSE-RELATED GENES – PRELIMINARY STUDY

Background

Ro52, also known as TRIM21, is an essential agent of the innate host defence, especially of the antiviral responses1. It was found to be induced by type I and II interferons. Due to its activity of E3 ligase, TRIM21 is involved in the ubiquitination of several IFN regulating factors (IRFs)2. Ro52 enables antibody-dependent intracellular neutralization as a high-affinity Fc immunoglobulin receptor1. The auto-ubiquitination of the TRIM21-related complex induces signalling pathways with the production of pro-inflammatory cytokines1. Anti-Ro52 autoantibodies are found in versatile autoimmune conditions. The hypothesis of our project assumes that viral infections in genetically susceptible individuals trigger overexpression of Ro52, followed by the production of autoantibodies, which suppress its function as the negative regulator of type I interferon responses, leading to enhanced production of proinflammatory agents that uphold autoimmune process.

Objectives

To compare the expression of antiviral response-related genes in patients with anti-Ro52 autoantibodies and healthy volunteers in order to assess the significance of anti-Ro52 in the antiviral defence.

Methods

Anti-Ro52+ patients, hospitalized at the Department of Rheumatology, Medical University of Lodz or treated in the united outpatient clinic were recruited. 19 patients with anti-Ro52 antibodies were included in the study group (mean age: 54,2 years, F:M ratio 14:5). Among them, 5 patients were diagnosed with primary Sjogren syndrome, 5 with idiopathic inflammatory myopathies, 4 with systemic lupus erythematosus, 1 with rheumatoid arthritis, 3 with overlapping syndromes and 1 was undergoing diagnosis of connective tissue disease at the time of the recruitment. Data on the diagnosis, clinical symptoms and laboratory results were collected from the patients and the available medical records. 10 healthy individuals without autoimmune disorders were recruited to the control group. Whole blood samples were collected from both anti-Ro52+ patients and healthy controls, PBMC were isolated using Biocoll reagent. RNA was isolated from each sample with RNeasy and cDNA synthesis was performed by RevertAid™ H Minus First Strand cDNA Synthesis Kit. The mRNA expression levels of TRIM, IRF3, IRF5, IRF7, NFκB, RIG-1, MDA5 genes were examined by quantitative real-time PCR with TaqMan™ Universal PCR Master Mix according to the manufacturer’s instructions. The expression levels of genes relative to that of GAPDH were calculated by delta Ct (ΔCt). The ΔCt value is the Ct value of the target gene subtracted its Ct value of GAPDH, ΔCt = Ct (Gene) − Ct (GAPDH). Therefore, the smaller the ΔCt values, the higher the expression levels of the target mRNA. The Mann–Whitney rank sum test was used to compare the control group and anti-Ro52+ patients.

Results

The ΔCt values for TRIM, IRF3, IRF5, IRF7, NFkB, RIG-1, MDA5 were found to be lower in the anti-Ro52+ group as compared to the control group, indicating higher mRNA expression of these genes in anti-Ro52+ patients. Statistical significance was reached for all of the examined genes but IRF3. Detailed results are presented in Table 1.

Table 1.

The ΔCt values for antiviral response-related genes in anti-Ro52+ patients and healthy controls. P – statistical significance

Anti-Ro52+ group ΔCtControl group ΔCtpTRIM4,916,64<0,0001IRF35,705,920,8482IRF54,455,68<0,0001IRF75,146,54<0,0001NFκB4,785,66<0,0001RIG-13,774,330,0188MDA55,086,82<0,0001

Conclusion

Presented results confirm the enhancement of the antiviral defence in anti-Ro52+ patients. As overexpression is observed independently in various connective tissue diseases, impaired response to viral infections via Ro52 pathways could indicate a common trigger factor of autoimmunity.

References

[1]doi: 10.3389/fimmu.2019.02049

[2]doi: 10.1016/j.jaut.2012.01.014

Disclosure of Interests

None declared

POS0253 PERSONALIZED RISK EVALUATION FOR OUTCOME PREDICTION IN ANCA ASSOCIATED VASCULITIS (AAV) USING LATENT CLASS ANALYSIS AND MACHINE LEARNING

Background

ANCA associated vasculitides (AAV) are a heterogeneous group of rare diseases with unknown etiology. In the most severe cases AAV can lead to end stage kidney disease or death. Since etiology and detailed pathogenesis of AAV is not known, the prediction of disease outcome at the time of diagnosis is challenging. Thus, there is an unmet need for tools to identify patients with the highest risk of organ dysfunction and death and apply effective personalized therapy.

Objectives

The aim of this work was to search for tools allowing outcome prediction at the time of AAV diagnosis. Early identification of patients, who are likely to develop severe organ dysfunction and death is crucial for appropriate disease management. Induction therapy in AAV relays on immunosuppressive drugs characterized by a high risk of severe side effects. Thus, their administration in high doses should be limited only to individual patients with an especially high risk of poor outcome.

Methods

We applied here two methods of identification of AAV patients at risk to develop severe organ dysfunction and death. First method (latent class analysis [LCA] followed by logistic regression) was meant to subcategorize patients and identify a subgroup at subjects at risk to develop chronic renal replacement therapy (CRRT) and death [1]. Second, served to assess individual poor outcome risk and was based on two machine learning (ML) classifiers, which by analyzing clinical information allow assigning computed risk for CRRT and death in an individual patient allowing to identify subjects with high risk of chronic replacement therapy (CRRT) and death. We have evaluated a number of different approaches to build the ML models (including logistic regression, support vector machines, random forests), and obtained the best results for the gradient boosting algorithm implementation called LightGBM [2]. It works as a sequential ensemble of so-called weak learners (decision trees) finally combined in a one prediction model. Both analyses were based on retrospective data from Polish national AAV registry (POLVAS) [3] including presently 565 GPA and 135 MPA patients. The parameters used were: demographic data and laboratory parameters, specific organ involvement, ANCA specificity and time between selected stages of the disease.

Results

LCA used on our AAV cohort identified four subphenotypes – three already previously proposed - and revealing a fourth clinically relevant subphenotype. This new subphenotype includes only GPA patients, usually diagnosed at a younger age as compared to other groups, and characterized by multiorgan involvement, high relapse rate, relatively high risk of death, but no end-stage kidney disease. Logistic regression analysis revealed significant differences in the risk of CRRT and death between those subphenotypes – the worst prognosis was found for severe MPO AAV. On the other hand, using ML approach we obtained an individual prediction model with potentially relevant clinical performance (ROC AUC of 0.85 for CRRT and 0.82 for death).

Conclusion

We consider results obtained encouraging. They may offer a new insight into AAV course based on data available at diagnosis, and create a solid foundation for potential clinical decision support system.

References

[1]Wójcik K et al. Subphenotypes of ANCA-associated vasculitis identified by latent class analysis. Clin Exp Rheumatol. 2021 Mar-Apr;39 Suppl 129(2):62-68.

[2]Ke G, at al. Light GBM: A Highly Efficient Gradient Boosting Decision Tree. Advances in Neural Information Processing Systems 30 (NIPS 2017), pp. 3149-3157.

[3]Wójcik K et al. Clinical characteristics of Polish patients with ANCA-associated vasculitides-retrospective analysis of POLVAS registry. Clin Rheumatol. 2019 Sep;38(9):2553-2563.

Acknowledgements

This work was supported by a grant from Polish National Science Center UMO-2018/31/B/NZ6/03898

Disclosure of Interests

None declared

SAT0635-HPR THE BURDEN OF SCLERODERMA FROM PATIENTS’ PERSPECTIVE

Background:

Scleroderma can significantly impair daily functioning by leading to multi-organ involvement and profound fatigue. Recent studies suggest that objective measures of the disease severity may not necessarily correspond with the patients’ perception1.

Objectives:

To evaluate the degree of disability and fatigue in patients with scleroderma, distinguish the most troublesome activities and assess which clinical symptoms had mostly impact on daily functioning.

Methods:

An online questionnaire was created and distributed to English-speaking patients with scleroderma by means of online support groups. The questionnaire contained inquiries about demographical data, clinical symptoms as well as the Scleroderma Health Assessment Questionnaire (SHAQ, comprised of HAQ-DI and specific VAS scales) and Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F). Standard and Alternative Disability Indexes (SDI and ADI) were counted based on answers in HAQ-DI part. Degrees of disability and fatigue, reflected by SDI, ADI and FACIT-F scores, were compared between subgroup of patients with and without particular clinical symptoms. Responses were analysed statistically.

Results:

Questionnaire was completed by 85 responders (mean age 48,93±14,4; 98,82% were female). Mean SDI was 1.09±0.66 with 41.18% of patients fulfilling the criteria of mild to moderate difficulty (SDI<1), 50.59% classified as moderate to severe disability (1≤SDI<2) and 8.24% being severely or very severely disabled (SDI≥2). Mean value of ADI was 0.93±0.61. 56.47 % of responders needed aid of the caregivers while gripping/opening, 31.76% while reaching and 29.41% while running errands and chores. Most frequently used facilitating devices included devices for gripping/opening (32.94%) and for maintaining hygiene (21.18%). Mean value of overall disease severity was estimated by VAS as 52.06±0.66. The mean values of VAS assessing the impact on daily living were respectively 48.16±29.28 for pain related to the disease, 43.34±34.94 for Raynaud’s, 41.86±34.59 for gastrointestinal problems, 31.60±31.38 for breathing difficulties and 20.85±33.47 for finger ulcers. Mean FACIT-F score was 23.62±11.88 yet 71.76% of patients fulfilled the criteria of severe fatigue. Both SDI and ADI correlated with FACIT-F score (respectively r=-0.5684, p<0.0001 and r=-0.5711, p<0.0001). SDI, ADI and FACIT-F correlated with VAS scores for overall disease severity, pain, gastrointestinal and breathing problems. Patients with symptoms such as arthralgia, muscle weakness, dysphagia, blurred vision, hair loss, unintentional weight loss and hoarseness were statistically more disabled and fatigued as compared to patients without such symptoms. Responders with skin ulcers/non-healing wounds (other than finger ulcers), Raynaud’s or erythema/rash were more disabled than responders without such symptoms, yet no differences were observed in the degree of fatigue.

Conclusion:

Majority of patients with scleroderma are moderately to severely disabled yet cope with the impairments with the widespread use of facilitating devices or aid of caregivers. Profound fatigue, observed in the majority of patients, may contribute to the high overall perception of disease severity.

References:

[1]Jaeger VK, Distler O, Mauer B et al. Functional disability and its predictors in systemic sclerosis: a study from the DeSScipher project within the EUSTAR group. Rheumatology (Oxford). 2018 Mar 1;57(3):441-450. doi: 10.1093/rheumatology/kex182

Disclosure of Interests:

None declared

Clinical approach on challenge and desensitization procedures with aspirin in patients with ischemic heart disease and nonsteroidal anti-inflammatory drug hypersensitivity

BACKGROUND

Hypersensitivity to acetylsalicylic acid (ASA) constitutes a serious problem for subjects with coronary artery disease. In such subjects, physicians have to choose the more appropriate procedure between challenge and desensitization. As the literature on this issue is sparse, this study aimed to establish in these subjects clinical criteria for eligibility for an ASA challenge and/or desensitization.

METHODS

Collection and analysis of data on ASA challenges and desensitizations from 10 allergy centers, as well as consensus among the related physicians and an expert panel.

RESULTS

Altogether, 310 subjects were assessed; 217 had histories of urticaria/angioedema, 50 of anaphylaxis, 26 of nonimmediate cutaneous eruptions, and 17 of bronchospasm related to ASA/nonsteroidal anti-inflammatory drugs (NSAID) intake. Specifically, 119 subjects had index reactions to ASA doses lower than 300 mg. Of the 310 subjects, 138 had an acute coronary syndrome (ACS), 101 of whom underwent desensitizations, whereas 172 suffered from a chronic ischemic heart disease (CIHD), 126 of whom underwent challenges. Overall, 163 subjects underwent challenges and 147 subjects underwent desensitizations; 86 of the latter had index reactions to ASA doses of 300 mg or less. Ten subjects reacted to challenges, seven at doses up to 500 mg, three at a cumulative dose of 110 mg. The desensitization failure rate was 1.4%.

CONCLUSIONS

In patients with stable CIHD and histories of nonsevere hypersensitivity reactions to ASA/NSAIDs, an ASA challenge is advisable. Patients with an ACS and histories of hypersensitivity reactions to ASA, especially following doses lower than 100 mg, should directly undergo desensitization.

In vitro tests for drug hypersensitivity reactions: an ENDA/EAACI Drug Allergy Interest Group position paper

Drug hypersensitivity reactions (DHRs) are a matter of great concern, both for outpatient and in hospital care. The evaluation of these patients is complex, because in vivo tests have a suboptimal sensitivity and can be time-consuming, expensive and potentially risky, especially drug provocation tests. There are several currently available in vitro methods that can be classified into two main groups: those that help to characterize the active phase of the reaction and those that help to identify the culprit drug. The utility of these in vitro methods depends on the mechanisms involved, meaning that they cannot be used for the evaluation of all types of DHRs. Moreover, their effectiveness has not been defined by a consensus agreement between experts in the field. Thus, the European Network on Drug Allergy and Drug Allergy Interest Group of the European Academy of Allergy and Clinical Immunology has organized a task force to provide data and recommendations regarding the available in vitro methods for DHR diagnosis. We have found that although there are many in vitro tests, few of them can be given a recommendation of grade B or above mainly because there is a lack of well-controlled studies, most information comes from small studies with few subjects and results are not always confirmed in later studies. Therefore, it is necessary to validate the currently available in vitro tests in a large series of well-characterized patients with DHR and to develop new tests for diagnosis.

The relation of airway obstruction to asthma, chronic rhinosinusitis and age: results from a population survey of adults

RATIONALE

There is conflicting evidence on whether patients with asthma experience an accelerated decline in lung function with age. We examined the association between postbronchodilator lung function, asthma, chronic rhinosinusitis (CRS), and atopy with age using a large European sample.

METHODS

In 17 centers in 11 European countries, case-control studies were nested within representative cross-sectional surveys of adults aged less than 75 years. Representative samples of participants with asthma, CRS or both and controls were assessed for postbronchodilator ventilatory function, smoking history, atopy, and treatment. Multiple regression was used to assess the interactive effects of age and diagnostic group on decline in postbronchodilator ventilatory function.

RESULTS

A total of 3337 participants provided adequate data (778 with asthma, 399 with CRS, 244 with both asthma and CRS and 1916 controls who had neither asthma nor CRS). Participants with asthma had lower FEV1 /FVC (-4.09% (95% CI: -5.02, -3.15, P < 0.001) and a steeper slope of FEV1 /FVC against age (-0.14%/annum [95%CI: -0.19, -0.08]) equivalent to smoking 1-2 packs of cigarettes per day. Those with atopy had a slope equivalent to controls.

CONCLUSIONS

People with asthma have a steeper decline in postbronchodilator lung function with age, but neither CRS nor atopy alone were associated with such decline.

Classification and practical approach to the diagnosis and management of hypersensitivity to nonsteroidal anti-inflammatory drugs

Hypersensitivity reactions to aspirin (acetylsalicylic acid) and other nonsteroidal anti-inflammatory drugs (NSAIDs) constitute only a subset of all adverse reactions to these drugs, but due to their severity pose a significant burden to patients and are a challenge to the allergist. In susceptible individuals, NSAIDs induce a wide spectrum of hypersensitivity reactions with various timing, organ manifestations, and severity, involving either immunological (allergic) or nonimmunological mechanisms. Proper classification of reactions based on clinical manifestations and suspected mechanism is a prerequisite for the implementation of rational diagnostic procedures and adequate patient management. This document, prepared by a panel of experts from the European Academy of Allergy and Clinical Immunology Task Force on NSAIDs Hypersensitivity, aims at reviewing the current knowledge in the field and proposes uniform definitions and clinically useful classification of hypersensitivity reactions to NSAIDs. The document proposes also practical algorithms for the diagnosis of specific types of NSAIDs hypersensitivity (which include drug provocations, skin testing and in vitro testing) and provides, when data are available, evidence-based recommendations for the management of hypersensitive patients, including drug avoidance and drug desensitization.

A case-control study of the relation between plasma selenium and asthma in European populations: a GAL2EN project

BACKGROUND

There is evidence that selenium levels are relatively low in Europe and may be falling. Low levels of selenium or low activity of some of the enzymes dependent on selenium have been associated with asthma.

METHODS

The GA(2)LEN network has organized a multicentre case-control study in Europe to assess the relation of plasma selenium to asthma. The network compared 569 cases in 14 European centres with a diagnosis of asthma and reporting asthma symptoms in the last 12 months with 576 controls from the same centres with no diagnosis of asthma and no asthmatic symptoms in the last 12 months.

RESULTS

All cases and controls were selected from the same population defined by age and place of residence. Mean plasma selenium concentrations among the controls ranged from 116.3 microg/l in Palermo to 67.7 microg/l in Vienna and 56.1 microg/l among the children in Oslo. Random effects meta-analysis of the results from the centres showed no overall association between asthma and plasma selenium [odds ratio (OR)/10 microg/l increase in plasma selenium: 1.04; 95% confidence interval (CI): 0.89-1.21] though there was a significantly protective effect in Lodz (OR: 0.48; 95% CI: 0.29-0.78) and a marginally significant adverse effect in Amsterdam (OR: 1.68; 95% CI: 0.98-2.90) and Ghent (OR: 1.35; 95% CI: 1.03-1.77).

CONCLUSION

This study does not support a role for selenium in protection against asthma, but effect modification and confounding cannot be ruled out.

The relation between paracetamol use and asthma: a GA2LEN European case-control study

Studies from the UK and USA suggest that frequent use of paracetamol (acetaminophen) may increase the risk of asthma, but data across Europe are lacking. As part of a multicentric case-control study organised by the Global Allergy and Asthma European Network (GA(2)LEN), it was examined whether or not frequent paracetamol use is associated with adult asthma across Europe. The network compared 521 cases with a diagnosis of asthma and reporting of asthma symptoms within the last 12 months with 507 controls with no diagnosis of asthma and no asthmatic symptoms within the last 12 months across 12 European centres. All cases and controls were selected from the same population, defined by age (20-45 yrs) and place of residence. In a random effects meta-analysis, weekly use of paracetamol, compared with less frequent use, was strongly positively associated with asthma after controlling for confounders. There was no evidence for heterogeneity across centres. No association was seen between use of other analgesics and asthma. These data add to the increasing and consistent epidemiological evidence implicating frequent paracetamol use in asthma in diverse populations.

The relation between paracetamol use and asthma: a GA2LEN European case-control study

Studies from the UK and USA suggest that frequent use of paracetamol (acetaminophen) may increase the risk of asthma, but data across Europe are lacking. As part of a multicentric case-control study organised by the Global Allergy and Asthma European Network (GA(2)LEN), it was examined whether or not frequent paracetamol use is associated with adult asthma across Europe. The network compared 521 cases with a diagnosis of asthma and reporting of asthma symptoms within the last 12 months with 507 controls with no diagnosis of asthma and no asthmatic symptoms within the last 12 months across 12 European centres. All cases and controls were selected from the same population, defined by age (20-45 yrs) and place of residence. In a random effects meta-analysis, weekly use of paracetamol, compared with less frequent use, was strongly positively associated with asthma after controlling for confounders. There was no evidence for heterogeneity across centres. No association was seen between use of other analgesics and asthma. These data add to the increasing and consistent epidemiological evidence implicating frequent paracetamol use in asthma in diverse populations.

Inhibition of nasal polyp mast cell and eosinophil activation by desloratadine

Nasal polyp tissue which contains mast cells and eosinophils is similar to the inflamed airway mucosa in cellular composition and mediator content. This investigation assessed the effect of desloratadine (DL), on activation of cells in nasal polyp tissue. Polyps were obtained from 22 patients with chronic rhinosinusitis [nine aspirin acetylosalitic acid (ASA)-sensitive and 13 ASA-tolerant]. Polyp tissue was dispersed by digestion, and preincubated with DL and incubated with anti-immunoglobulin E (IgE) or calcium ionophore. LTC4, eosinophil cationic protein (ECP) and tryptase concentrations in supernatants were measured by immunoassays. Desloratadine (1, 10 and 50 microM) inhibited calcium ionophore-induced LTC4 release by a mean of 29%, 50% and 63% respectively, and anti-IgE-induced LTC4 release by a mean of 27%, 35% and 39% respectively. Calcium ionophore-induced tryptase release was inhibited 60% and 69% by 10 and 50 microM of DL, respectively, and anti-IgE-induced tryptase release was inhibited 33%, 47% and 66% for 1, 10 and 50 microM of DL. Desloratadine 10 microM and 50 microM inhibited ECP release by and 45% and 48% respectively. Polyp tissue from ASA-sensitive patients when compared with ASA-tolerant patients released at baseline significantly more ECP (medians 120.0 microg/ml, range: 69.0-182.0 vs 63.4 microg/ml, range: 3.7-172.0; P <0.05), but similar amounts of tryptase and LTC4. This study demonstrated that DL inhibits activation of both eosinophils and mast cells derived from a site of airway mucosal inflammation.

[Nephropathy in the course of inflammatory connective tissue diseases]

The aim of the study was to assess the frequency of renal complications and also evaluation of renal efficiency with regard to sex and age in children with inflammatory connective tissue diseases. The examination embraced 18 children out of 5657 hospitalised in 19991-1998 in Military University School of Medicine-Dpt of Pediatrics suffering from inflammatory connective tissue diseases, which constitutes 0.32%. They found the following number of isolated cases: 9 cases of juvenile chronic arthritis (JCA), 6 cases of rheumatic fever (RF), and 3 cases of systemic lupus erythematosus (SLE). There were 9 girls and 9 boys. The most frequent symptom of kidneys affection was erythrocyturia. Due to chronic course, reccurrence and the possibility of further complications, children with inflammatory connective tissue diseases, after discharging from hospital, should stay under the care of rheumatological outpatient clinic.

[Nephropathy in the course of Schönlein-Henoch purpura]

The aim of the study was to assess the frequency of renal complications and also evaluation of renal efficiency with regard to sex and age in children with Schonlein-Henoch purpura. 31 children with Schonlein-Henoch disease out of 5004 hospitalised in 6 years time (1994-1999) in Mil. Medical University-Dpt of Pediatrics, underwent the examination, which is 0.62% of all patients. The group of analysed cases consisted of 19 girls (61.3%) and 12 boys (38.7%). 15 of them had changes in kidneys, which constitutes 48.4%. The average age of examined children was 9.1 years. In the most cases upper respiratory tract infections preceded symptoms of the Schonlein-Henoch purpura. The most often complications found in the course of the Schonlein-Henoch purpura were renal ones. The most numerous renal complications affected children between 7 and 9 years of age. Because of chronic and insidious course of the disease, children, after discharging from hospital should stay under specialistic medical care.