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Bae, Lee, Kim, Jung, Kim, Lee, Ahn, Park, Lee, Kang, Lee, Kim, and Suh: Initial Hematochezia and Kidney Involvement are Important Prognostic Factors of Adult Onset Henoch-Schönlein Purpura in Korea
Original Article
Journal of Rheumatic Diseases

Journal of Rheumatic Diseases 2012; 19(5): 254-261.

Published online: 31 October 2012

DOI: https://doi.org/10.4078/jrd.2012.19.5.254

Initial Hematochezia and Kidney Involvement are Important Prognostic Factors of Adult Onset Henoch-Schönlein Purpura in Korea

Chang-Bum Bae, Jin-Woo Lee, Hyoun-Ah Kim, Ju-Yang Jung, Han Gyeol Kim, Mi Yeon Lee, Seun Joo Ahn, Hae-lin Park, Hyo-Jin Lee, Eunjung Kang, Min-Jeong Lee, Sei Rhan Kim, Chang-Hee Suh

Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea.

Corresponding to: Chang-Hee Suh, Department of Rheumatology, Ajou University School of Medicine, San 5, Wonchon-dong, Yeongtong-gu, Suwon 443-721, Korea. chsuh@ajou.ac.kr

Received 11 June 2012       Revised 15 August 2012       Accepted 28 August 2012

Copyright © 2012 by The Korean College of Rheumatology

(free-access):

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

Henoch-Schönlein purpura (HSP) is a systemic vasculitis, characterized by small-vessel leukocytoclastic vasculitis with the deposition of immune complexes containing IgA. It is the most common acute vasculitic disorder affecting children but is relatively uncommon in adults. We investigated the clinical features and factors affecting the prognosis of adult HSP in Korea.

Methods

From 1996 to 2011 seventy patients over 15 years of age with HSP were retrospectively analyzed.

Results

Thirty eight patients (54.3%) were female and the age at disease onset ranged from 15 to 75 years (35.0±15.8 years). Purpuric skin rash was observed in all patients and arthralgia was present in 34 patients (48.6%). GI symptoms and kidney involvements were observed in 28 patients (40.0%) and 34 patients (48.6%), respectively. Complete remission was achieved in 46 patients (65.7%). The remission group showed a lower incidence of hematochezia (p=0.044), hematuria (p=0.008), and proteinuria (p=0.011) at diagnosis than the no remission group. About 10% of adult HSP patient progressed to chronic kidney disease (CKD), which showed higher a incidence of nephrotic range proteinuria. Only nephrotic range proteinuria at diagnosis was a significant risk factor for CKD (OR=16.7, p=0.008, 95% CI=2.1~133.1).

Conclusion

Hematochezia, hematuria and proteinuria at the diagnosis of HSP are important prognostic factors in predicting remission. In addition, HSP patients with nephrotic range proteinuria at diagnosis have an increased risk of renal failure.

Keywords: Henoch-Schönlein purpura, Remission, Proteinuria, Prognosis

Figures and Tables

Table 1
Clinical and demographic characteristics of 70 patients
jrd-19-254-i001
Table 2
Clinical features of 70 patients
jrd-19-254-i002
Table 3
Laboratory findings of 70 patients
jrd-19-254-i003

WBC: white blood cell, ESR: erythrocyte sedimentation rate, CRP: C-reactive protein, AST: aspartate aminotransferase, ALT: alanine transaminases, C: complement, IgA: immunoglobulin A, ASO: anti-streptolysin O

Table 4
Outcome of 70 patients at last follow up
jrd-19-254-i004
Table 5
Clinical characteristics and treatment according to complete remission
jrd-19-254-i005

Steroid: prednisolone, Immunosuppressant: cyclophosphamide or azathioprine. These data were assessed using Fisher's exact test.

Table 6
Clinical characteristics and treatment of HSP patients with nephritis
jrd-19-254-i006

CKD: chronic kidney disease, Renal biopsy findings classified by ISKDC, ISKDC: international study of kidney diseases in children, Steroid: prednisolone, Immunosuppressant: cyclophosphamide or azathioprine. These data were assessed using Fisher's exact test

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