Skip to main content
NCBI home page
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 2005 May 4;90(9):916–920. doi: 10.1136/adc.2005.074641

Risk of long term renal impairment and duration of follow up recommended for Henoch-Schönlein purpura with normal or minimal urinary findings: a systematic review

H Narchi 1
PMCID: PMC1720564  PMID: 15871983

Abstract

Background: The duration of follow up to assess the risk of long term renal impairment in Henoch-Schönlein purpura (HSP) without nephritic or nephrotic syndrome or renal failure on diagnosis remains undetermined.

Aims: To undertake a systematic review of the literature to assess whether the risk of long term renal impairment without renal involvement on diagnosis could be estimated and to determine the time period when renal involvement is very unlikely after the diagnosis of HSP.

Methods: Search of studies of unselected children with HSP, and available information on urinary findings, renal involvement, and long term renal function follow up. Studies of selected children with HSP nephropathy at diagnosis were excluded.

Results: Twelve studies of 1133 children were reviewed. The follow up period ranged from 6 weeks to 36 years. Proteinuria and/or haematuria, which occurred in 34.2%, of which only one fifth were in association with nephritic or nephrotic syndrome, developed in 85% of cases within 4 weeks of the diagnosis of HSP, in 91% within 6 weeks, and in 97% within 6 months. Permanent renal impairment never developed after normal urinalysis; it occurred in 1.6% of those with isolated urinary abnormalities, and in 19.5% of those who developed nephritic or nephrotic syndrome.

Conclusion: No long term renal impairment occurred after normal urinalysis. Even if urinalysis is normal at presentation, the testing should be continued for six months. There is no need to follow up after the first six months those whose urinalysis remains normal.

Full Text

The Full Text of this article is available as a PDF (68.4 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abdel-Al Y. K., Hejazi Z., Majeed H. A. Henoch Schönlein purpura in Arab children. Analysis of 52 cases. Trop Geogr Med. 1990 Jan;42(1):52–57. [PubMed] [Google Scholar]
  2. Astulfoni A., Casati A., Ruggeri M., Ciocca N., Mora C. Sindrome di Schonlein-Henoch. Considerazioni a proposito di 95 casi pediatrici. Minerva Pediatr. 1996 May;48(5):201–208. [PubMed] [Google Scholar]
  3. Blanco R., Martínez-Taboada V. M., Rodríguez-Valverde V., García-Fuentes M., González-Gay M. A. Henoch-Schönlein purpura in adulthood and childhood: two different expressions of the same syndrome. Arthritis Rheum. 1997 May;40(5):859–864. doi: 10.1002/art.1780400513. [DOI] [PubMed] [Google Scholar]
  4. Calviño M. C., Llorca J., García-Porrúa C., Fernández-Iglesias J. L., Rodriguez-Ledo P., González-Gay M. A. Henoch-Schönlein purpura in children from northwestern Spain: a 20-year epidemiologic and clinical study. Medicine (Baltimore) 2001 Sep;80(5):279–290. doi: 10.1097/00005792-200109000-00001. [DOI] [PubMed] [Google Scholar]
  5. Chen W. P., Lin C. Y., Cheng J. H., Hwang B. T. Purpura nephritis in Chinese children from northern Taiwan. Child Nephrol Urol. 1988;9(6):331–336. [PubMed] [Google Scholar]
  6. Coakley J. C., Chambers T. L. Should we follow up children with Henoch-Schönlein syndrome? Arch Dis Child. 1979 Nov;54(11):903–904. doi: 10.1136/adc.54.11.903. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Coppo R., Amore A., Gianoglio B. Clinical features of Henoch-Schönlein purpura. Italian Group of Renal Immunopathology. Ann Med Interne (Paris) 1999 Feb;150(2):143–150. [PubMed] [Google Scholar]
  8. Coppo R., Mazzucco G., Cagnoli L., Lupo A., Schena F. P. Long-term prognosis of Henoch-Schönlein nephritis in adults and children. Italian Group of Renal Immunopathology Collaborative Study on Henoch-Schönlein purpura. Nephrol Dial Transplant. 1997 Nov;12(11):2277–2283. doi: 10.1093/ndt/12.11.2277. [DOI] [PubMed] [Google Scholar]
  9. Counahan R., Winterborn M. H., White R. H., Heaton J. M., Meadow S. R., Bluett N. H., Swetschin H., Cameron J. S., Chantler C. Prognosis of Henoch-Schönlein nephritis in children. Br Med J. 1977 Jul 2;2(6078):11–14. doi: 10.1136/bmj.2.6078.11. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Dawod S. T., Akl K. F. Henoch-Schöenlein syndrome in Qatar: the effects of steroid therapy and paucity of renal involvement. Ann Trop Paediatr. 1990;10(3):279–284. doi: 10.1080/02724936.1990.11747443. [DOI] [PubMed] [Google Scholar]
  11. Farine M., Poucell S., Geary D. L., Baumal R. Prognostic significance of urinary findings and renal biopsies in children with Henoch-Schönlein nephritis. Clin Pediatr (Phila) 1986 May;25(5):257–259. doi: 10.1177/000992288602500505. [DOI] [PubMed] [Google Scholar]
  12. Fischer P. J., Hagge W., Hecker W. Purpura Schönlein-Henoch. Eine klinische Studie an 119 Patienten unter besonderer Berücksichtigung ungewöhnlicher Komplikationen. Monatsschr Kinderheilkd. 1990 Mar;138(3):128–134. [PubMed] [Google Scholar]
  13. García-Porrúa Carlos, Calviño Maria C., Llorca Javier, Couselo José M., González-Gay Miguel A. Henoch-Schönlein purpura in children and adults: clinical differences in a defined population. Semin Arthritis Rheum. 2002 Dec;32(3):149–156. doi: 10.1053/sarh.2002.33980. [DOI] [PubMed] [Google Scholar]
  14. Goldstein A. R., White R. H., Akuse R., Chantler C. Long-term follow-up of childhood Henoch-Schönlein nephritis. Lancet. 1992 Feb 1;339(8788):280–282. doi: 10.1016/0140-6736(92)91341-5. [DOI] [PubMed] [Google Scholar]
  15. Halling Stella F. Edström, Söderberg Magnus P., Berg Ulla B. Henoch Schönlein nephritis: clinical findings related to renal function and morphology. Pediatr Nephrol. 2004 Oct 22;20(1):46–51. doi: 10.1007/s00467-004-1650-6. [DOI] [PubMed] [Google Scholar]
  16. Ilan Y., Naparstek Y. Schönlein-Henoch syndrome in adults and children. Semin Arthritis Rheum. 1991 Oct;21(2):103–109. doi: 10.1016/0049-0172(91)90043-y. [DOI] [PubMed] [Google Scholar]
  17. Koskimies O., Mir S., Rapola J., Vilska J. Henoch-Schönlein nephritis: long-term prognosis of unselected patients. Arch Dis Child. 1981 Jun;56(6):482–484. doi: 10.1136/adc.56.6.482. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Kumar L., Singh S., Goraya J. S., Uppal B., Kakkar S., Walker R., Sehgal S. Henoch-Schonlein purpura: the Chandigarh experience. Indian Pediatr. 1998 Jan;35(1):19–25. [PubMed] [Google Scholar]
  19. Lin S. J., Huang J. L. Henoch-Schönlein purpura in Chinese children and adults. Asian Pac J Allergy Immunol. 1998 Mar;16(1):21–25. [PubMed] [Google Scholar]
  20. Meadow S. R., Glasgow E. F., White R. H., Moncrieff M. W., Cameron J. S., Ogg C. S. Schönlein-Henoch nephritis. Q J Med. 1972 Jul;41(163):241–258. [PubMed] [Google Scholar]
  21. Mollica F., Li Volti S., Garozzo R., Russo G. Effectiveness of early prednisone treatment in preventing the development of nephropathy in anaphylactoid purpura. Eur J Pediatr. 1992 Feb;151(2):140–144. doi: 10.1007/BF01958961. [DOI] [PubMed] [Google Scholar]
  22. Moriya S., Iitaka K., Koshino H., Tomonaga K., Kasai N. [Henoch-Schönlein purpura nephritis (HSPN) in children: comparison of the incidence and severity between two 12-year groups]. Nihon Jinzo Gakkai Shi. 2000 Jan;42(1):36–40. [PubMed] [Google Scholar]
  23. Olivier C., de Paillerets F. Le purpura rhumatoïde de l'enfant. Expérience clinique d'un service de pédiatrie générale. Ann Pediatr (Paris) 1988 Nov;35(9):641–644. [PubMed] [Google Scholar]
  24. Pabunruang Wasuthida, Treepongkaruna Suporn, Tangnararatchakit Kanchana, Chunharas Amornsri, Phuapradit Pornpimon. Henoch-Schonlein purpura: clinical manifestations and long-term outcomes in Thai children. J Med Assoc Thai. 2002 Nov;85 (Suppl 4):S1213–S1218. [PubMed] [Google Scholar]
  25. Ronkainen Jaana, Nuutinen Matti, Koskimies Olli. The adult kidney 24 years after childhood Henoch-Schönlein purpura: a retrospective cohort study. Lancet. 2002 Aug 31;360(9334):666–670. doi: 10.1016/S0140-6736(02)09835-5. [DOI] [PubMed] [Google Scholar]
  26. Sano Hitomi, Izumida Michiko, Shimizu Hiroshi, Ogawa Yunosuke. Risk factors of renal involvement and significant proteinuria in Henoch-Schönlein purpura. Eur J Pediatr. 2002 Apr;161(4):196–201. doi: 10.1007/s00431-002-0922-z. [DOI] [PubMed] [Google Scholar]
  27. Saulsbury F. T. Henoch-Schönlein purpura in children. Report of 100 patients and review of the literature. Medicine (Baltimore) 1999 Nov;78(6):395–409. doi: 10.1097/00005792-199911000-00005. [DOI] [PubMed] [Google Scholar]
  28. Stewart M., Savage J. M., Bell B., McCord B. Long term renal prognosis of Henoch-Schönlein purpura in an unselected childhood population. Eur J Pediatr. 1988 Feb;147(2):113–115. doi: 10.1007/BF00442205. [DOI] [PubMed] [Google Scholar]
  29. Sönmez F., Mir S., Cura A., Cakir D., Başdemir G. Clinicopathologic correlations of Henoch-Schönlein nephritis in Turkish children. Pediatr Int. 1999 Aug;41(4):353–356. doi: 10.1046/j.1442-200x.1999.01087.x. [DOI] [PubMed] [Google Scholar]
  30. Wang Y. J., Chi C. S., Shian W. J. Clinical studies of Henoch-Schönlein purpura in Chinese children. Zhonghua Yi Xue Za Zhi (Taipei) 1993 May;51(5):345–349. [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES