Nephrology Dialysis Transplantation, Vol 12, Issue 11 2277-2283, Copyright © 1997 by Oxford University Press
R Coppo, G Mazzucco, L Cagnoli, A Lupo, F Schena and f the Italian Group of Renal Immunopathology Collaborative Study on Henoch-Schonlein purpura
Background: The aim of this multicentre collaborative
study was to compare the progression of renal disease in children and
adults with Henoch-Schonlein purpura (HPS) nephritis selected on the basis
of IgA-dominant renal deposits and biopsy material available for review.
Methods: The analysis was performed in 152 patients
(95 adults and 57 children <16 years old at diagnosis) with a
follow-up (⩽1 year up to 20 years (4.9±3.4 years in
adults and 4.8±3.9 years in children).
Results: Renal histology and clinical presentation
were similar in both age groups: crescents were found in 36% of adults and
34.6% of children (in only 2.7% of adults and 1.9% of children involving
>50% of glomeruli), nephrotic-range proteinuria in 29.5% of adults
and 28/.1% of children and functional impairment in 24.1% of adults and
36.9% of children. The outcome was similar for both age groups (remission,
32.5% of adults and 31.6% of children; renal function impairment, 31.6% of
adults and 24.5% of children). End-stage renal disease was observed in
15.8% of adults and in 7% of children. Renal function survival at 5 years
was not significantly different in the two groups (85% in adults and 95% in
children) and at 10 years it was approximately 75% in both groups. None of
the children died and adult survival was 97% at 5 years. In adults at
presentation, renal function impairment (P <0.02) as well as
proteinuria higher than 1.5 g/day (P <0.02) and hypertension (P
<0.001) were negative prognostic factors. Multivariate analysis
stressed the main statistical relevance of proteinuria (relative risk 2.37,
P <0.02). Conversely, in children no definite level of proteinuria,
hypertension or other data were found to be associated with poor prognosis.
Conclusion: Among patients with a clinical
presentation which warrants renal biopsy, HSP nephritis has a similar
prognosis in children and adults. The evolution is more predictable in
adults than in children. Key words: Henoch-Schonlein
purpura nephritis; IgA nephropathy; prognostic indicators in nephritis;
proteinuria; hypertension; paediatric nephrology
ORIGINAL ARTICLES
Long-term prognosis of Henoch-Schonlein nephritis in adults and children
Nephrology and Dialysis Department, Regina Margherita Children's Hospital, Piazza Polonia 94, I-10126 Torino, Italy; Ospedale Provinciale 'Degli Infermi', Rimini, Italy; Cattedra di Nefrologia, Ospedale 'Civile Maggiore, Verona, Italy; Istituto di Nefrologia, Ospedale 'Policlinico', Bari, Italy; Corresponding author
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