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Kang, Ha, Lee, Jung, Lee, Lee, and Park: Clinical Manifestations of Korean Adult Patients with Henoch-Schönlein Purpura
Original Article

J Korean Rheum Assoc 2010;17(2):133-142.

Published online: 23 June 2010

DOI: https://doi.org/10.4078/jkra.2010.17.2.133

Clinical Manifestations of Korean Adult Patients with Henoch-Schönlein Purpura

Yoon Kang, You-Jung Ha, Kwang-Hoon Lee, Sang-Youn Jung, Sang-Won Lee, Soo-Kon Lee, Yong-Beom Park

Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea

Copyright © 2010 The Korean Rheumatism Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

We investigated the clinical data and analyzed the significant prognostic factors for outcomes in Korean adult patients with Henoch-Schönlein Purpura (HSP).

Methods

We retrospectively reviewed the medical records of 52 patients over 20 years-old, who visited the Yonsei University Severance Hospital from December 1999 to November 2009, and fulfilled the classification criteria for HSP. We investigated the epidemiologic data, clinical features, renal biopsy findings, laboratory results and disease outcomes.

Results

The median age was 43.5 (20~83) years old and 29 out of 52 patients (55.8%) were male. HSP exhibited seasonal variation and most frequently developed in winter (42.3%), followed by spring (25.0%). Upper respiratory infection was the most common known preceding event for HSP development. Skin manifestations were observed in all subjects, followed by kidney (80.8%), gastro-intestine (57.7%) and joints (26.9%). After a median follow-up period 14.5 (1~227) months, 12 patients experienced HSP relapse (23.1%), and 7 patients had chronic renal failure (13.4%). Univariate analysis showed that renal insufficiency (p=0.002) and nephritic syndrome (p=0.026) at diagnosis were significantly related to the development of chronic renal failure. Of the two parameters, only initial renal insufficiency was found to be a significant predictive value for chronic renal failure (OR=28.7, p=0.001, 95% confidential interval 3.6~225.3).

Conclusion

Renal insufficiency at diagnosis may be a useful predictive factor for progression to chronic renal failure in Korean adult patients with HSP.

Keywords: Henoch-Schönlein Purpura, Adult, Clinical manifestation, Prognosis, Chronic renal failure

REFERENCES

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Table 1.
Clinical and demographic characteristics of 52 adults with HSP
Sex (%) Patients (N=52)
Male 29 (55.8)
Female 23 (44.2)
Median age (year) 43.5 (20~83)
Season of initial presentation (%)
Spring 13 (25.0)
Summer 11 (21.2)
Autumn 6 (11.5)
Winter 22 (42.3)
Predisposing factor (%)
URI 13 (25.0)
Drug 6 (11.5)
Tumor 5 (9.6)
Pancreatitis 1 (1.9)
Food poisoning 1 (1.9)
Unknown 26 (50.0)
Hypertension (%)
Yes 19 (36.5)
No 33 (63.5)

URI: upper respiratory infection

Table 2.
Clinical features of 52 adults with HSP
Patients (%)
Skin manifestations 52 (100.0)
Lower extremities only 25 (48.1)
Lower and upper extremities 14 (26.9)
Lower extremities and trunk 3 (5.8)
Lower and upper extremities and trunk 10 (19.2)
Joint manifestations 14 (26.9)
Monoarthritis 3 (5.8)
Oligoarthritis 9 (17.3)
Polyarthritis 2 (3.8)
GI manifestations 30 (57.7)
Abdominal discomfort 4 (7.7)
Abdominal pain 26 (50)
Diarrhea 7 (13.5)
Hematochezia 9 (17.3)
Renal manifestations 42 (80.8)
Microscopic hematuria 38 (73.1)
Gross hematuria 5 (9.6)
Table 3.
Renal biopsy findings of 23 adults with HSP nephritis
Grade Patients (%)
I 2 (8.7)
II 5 (21.7)
III 15 (65.2)
IV 1 (4.3)
V 0 (0)
VI 0 (0)

Renal biopsy findings were classified into one of six subtypes by the classification of international study of kidney disease in children (ISKDC)

Table 4.
Laboratory findings of 52 adults with HSP
Patients (%)
Leukocytosis 19/52 (36.5)
Anemia 17/52 (32.7)
Thrombocytopenia 2/52 (3.8)
Increased ESR 24/40 (60.0)
Increased CRP 28/44 (63.6)
Increased IgA 12/41 (29.3)

ESR: erythrocyte sediment rate, CRP: C-reactive protein

Table 5.
Outcome of 52 adults with HSP at last follow up
Follow up months Months
Mean 33.5 ± 40.8
Median 14.5
Range 1~227
Outcome Patients (%)
Complete recovery 19 (36.6)
Relapse 12 (23.1)
Persistent hematuria or proteinuria 26 (50.0)
Chronic renal failure 7 (13.4)
Table 6.
Univariate & multivariate analysis of factors associated with chronic renal failure
Factors N (%) P
Sex
Male 5/29 (17.2)
Female 2/23 (8.7) 0.444
Age (year)
≤50 2/30 (6.7)
>50 5/22 (22.7) 0.119
Hypertension
No 3/33 (9.1)
Yes 4/19 (21.1) 0.4
Arthralgia
No 7/38 (18.4)
Yes 0/14 (0.0) 0.169
GI involvement
No 4/22 (18.2)
Yes 3/30 (10.0) 0.438
Leukocytosis
No 5/33 (15.2)
Yes 2/19 (10.5) 1.0
Anemia
No 3/35 (8.6)
Yes 4/17 (23.5) 0.198
Thrombocytopenia
No 7/50 (14.0)
Yes 0/2 (0.0) 1.0
Immunosuppressant
No 2/22 (9.1)
Yes 5/30 (16.7) 0.685
Hematruria
No 0/9 (0.0)
Yes 7/43 (16.3) 0.331
Proteinuria
No 1/25 (4.0)
Yes 6/27 (22.2) 0.101
Renal insufficiency
No 3/46 (6.5)
Yes 4/6 (66.7) 0.002∗
Nephrotic syndrome
No 4/46 (8.7)
Yes 3/6 (50.0) 0.026∗
∗p<0.05
Table 7.
Multivariate analysis of factors associated with chronic renal failure
Factors OR (95% CI) P
Renal insufficiency 28.7 (3.6~225.3) 0.001∗

∗Multiple logistic regression by forward selection method CI: confidence interval, OR: odd ratio

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