Clinical Features and Prognosis of Henoch-Schönlein Purpura in Children and Adults: A 13-Year Retrospective Study at a Single Centre
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Purpose: To investigate differences in clinical features, blood/urinary findings, and prognosis in different age groups of patients with Henoch-Schönlein purpura (HSP). Methods: A total of 469 patients with HSP were analyzed retrospectively from June 2003 to February 2016. We classified patients into child or adult groups based on their age. Results: The adult group had more patients with anemia (child vs. adult; 7.5% vs. 16.4%), and higher immunoglobulin A (IgA) (30.0% vs. 50.0%) levels, C-reactive protein (34.2% vs. 54.0%) and uric acid (3.1% vs. 12.1%) levels than the child group. The child group was highly positive for Mycoplasma pneumoniae immunoglobulin M (IgM) (34.4%). More patients in the child group presented with high levels of antistreptolysin O (24.7% vs. 2.9%) and high C4 (11.5% vs. 4.2%). Low C3 (1.1% vs. 10.2%) levels, and renal involvement with gross hematuria (8.6% vs. 21.5 %), nonnephrotic proteinuria (1.1% vs. 11.2%), and nephrotic syndrome (1.1% vs. 6.0%) were common in the adult group. Adults also had poorer renal outcomes [persistent hematuria/proteinuria (10.5% vs. 32.8%), and chronic kidney disease (0% vs. 11.2%)] than the child group. Risk factors for renal involvement such as older age and higher level of uric acid were only found in the child group. The risk factors for poor renal outcome were nephrotic syndrome in the child group and gross hematuria in the adult group. Conclusion: In this study, child and adult groups presented with different clinical manifestations of HSP. We found that risk factors for renal involvement included age and high uric acid level in the child group. Moreover, nephrotic syndrome in the child group and gross hematuria in the adult group increased the risk of poor renal outcome.
Abstract
Purpose: To investigate differences in clinical features, blood/urinary findings, and prognosis in different age groups of patients with Henoch-Schönlein purpura (HSP). Methods: A total of 469 patients with HSP were analyzed retrospectively from June 2003 to February 2016. We classified patients into child or adult groups based on their age. Results: The adult group had more patients with anemia (child vs. adult; 7.5% vs. 16.4%), and higher immunoglobulin A (IgA) (30.0% vs. 50.0%) levels, C-reactive protein (34.2% vs. 54.0%) and uric acid (3.1% vs. 12.1%) levels than the child group. The child group was highly positive for Mycoplasma pneumoniae immunoglobulin M (IgM) (34.4%). More patients in the child group presented with high levels of antistreptolysin O (24.7% vs. 2.9%) and high C4 (11.5% vs. 4.2%). Low C3 (1.1% vs. 10.2%) levels, and renal involvement with gross hematuria (8.6% vs. 21.5 %), nonnephrotic proteinuria (1.1% vs. 11.2%), and nephrotic syndrome (1.1% vs. 6.0%) were common in the adult group. Adults also had poorer renal outcomes [persistent hematuria/proteinuria (10.5% vs. 32.8%), and chronic kidney disease (0% vs. 11.2%)] than the child group. Risk factors for renal involvement such as older age and higher level of uric acid were only found in the child group. The risk factors for poor renal outcome were nephrotic syndrome in the child group and gross hematuria in the adult group. Conclusion: In this study, child and adult groups presented with different clinical manifestations of HSP. We found that risk factors for renal involvement included age and high uric acid level in the child group. Moreover, nephrotic syndrome in the child group and gross hematuria in the adult group increased the risk of poor renal outcome.
참고문헌 (38)
- Narchi H, "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", Arch Dis Child, 90, pp.916~920 (2005)
- Goldstein AR, "Long-term followup of childhood Henoch-Schönlein nephritis", The Lancet, 339, pp.280~282 (1992)
- Pillebout E, "Henoch-Schönleinpurpura in adults: outcome and prognostic factors", J Am SocNephrol, 13, pp.1271~1278 (2002)
- Ronkainen J, "The adult kidney 24 years after childhood Henoch-Schönlein purpura: a retrospective cohort study", The Lancet, 360, pp.666~670 (2002)
- García-Porrúa C, "Henoch-Schönlein purpura in children and adults: clinical differences in a defined population", Semin Arthritis Rheum, 32, pp.149~156 (2002)
- Trapani S, "Henoch Schonlein purpura in childhood: epidemiological and clinical analysis of 150 cases over a 5-year period and review of literature", Semin Arthritis Rheum, 35, pp.143~153 (2005)
- Komatsu, H, "Clinical manifestations of Henoch–Schönlein purpura nephritis and IgA nephropathy: comparative analysis of data from the Japan Renal Biopsy Registry (J-RBR)", Clin Exp Nephrol, 20, pp.552~560 (2016)
- Ozen S, "EULAR", PRINTO, Ann Rheum Dis, pp.2010, 69[DOI]
- Stanley F. Lo, "Nelson Textbook of Pediatrics", pp.3464~3473 (2015), Elsevier
- Kratz A, "Harrison's Principles of Internal Medicine", pp.2754~2764 (2014), McGraw-Hill
- Hung SP, "Clinical manifestations and outcomes of Henoch-Schönlein purpura:comparison between adults and children", Pediatr Neonatol, 50, pp.162~168 (2009)
- 강윤, "Differences in Clinical Manifestations and Outcomes between Adult and Child Patients with Henoch-Schönlein Purpura", Journal of Korean Medical Science, 29(2), pp.198~203 (2014), 대한의학회
- Veraldi S, "Henoch-Schonlein syndrome associated with human Parvovirus B19primary infection", Eur J Dermatol, 9, pp.232~233 (1999)
- Saulsbury FT, "Henoch-Schonlein Purpura in Children: Report of 100 Patients and Review of the Literature", Medicine, 78, pp.395~409 (1999)
- Drago F, "Henoch‐Schönlein purpura induced by fluoroquinolones", Br J Dermatol, 131, pp.448~ (1994)
- Borrás-Blasco J, "Henoch-Schönlein purpura associated with clarithromycin. Case report and review of literature", IntJ Clin Pharmacol Ther, 41, pp.213~216 (2003)
- Blanco R, "Henoch-Schönlein purpura as a clinical presentation of small cell lung cancer", ClinExpRheumatol, 15, pp.545~547 (1997)
- Zickerman AM, "IgA myeloma presenting as Henoch-Schönlein purpura with nephritis", Am J Kidney Dis, 36, pp.E19.1~E19.5 (2000)
- Garcias VA, "Henoch-Schonlein purpura associated with cancer of prostate", Urology, 19, pp.155~158 (1982)
- Blanco P, "Henoch-Schönlein purpura associated with segmental and focal proliferative glomerulonephritis in a patient with Hodgkin's disease", Nephrol Dial Transplant, 14, pp.179~180 (1999)
- Day C, "Henoch‐Schönlein nephritis and non‐Hodgkin's lymphoma", Nephrol Dial Transplant, 16, pp.1080~1081 (2001)
- Hung SP, "Clinical manifestations and outcomes of Henoch-Schönlein purpura:comparison between adults and children", PediatrNeonatol, 50, pp.162~168 (2009)
- Goldstein, "Long-term follow-up of childhood Henoch-Schönlein nephritis", Lancet, 339, pp.280~282 (1992)
- Schärer K, "Clinical outcome of Schönlein-Henoch purpura nephritis in children", Pediatr Nephrol, 13, pp.816~823 (1999)
- Calviño MC, "Henoch-Schönlein purpura in children from northwestern Spain: a 20-year epidemiologic and clinical study", Medicine, 80, pp.279~290 (2001)
- Butani L, "Long-term outcome in children after Henoch-Schonlein purpura nephritis", Clin Pediatr, 46, pp.505~511 (2007)
- Ronkainen J, "The adult kidney 24 years after childhood Henoch-Schönlein purpura: a retrospective cohort study", Lancet, 360, pp.666~670 (2002)
- Pillebout E, "Henoch-Schönlein Purpura in adults: outcome and prognostic factors", J Am Soc Nephrol, 13, pp.1271~1278 (2002)
- Rosanna Coppo, "Predictors of Outcome in Henoch-Schönlein Nephritis in Children and Adults", Am J Kidney Dis, 47, pp.993~1003 (2006)
- Shi Y, "Clinical outcome of hyperuricemia in IgA nephropathy: a retrospective cohort study and randomized controlled trial", Kidney Blood Press Res, 35, pp.153~160 (2012)
- Calviño MC, "Henoch-Schönlein purpura in children from northwestern Spain: a 20-year epidemiologic and clinical study", Medicine, 80, pp.279~290 (2001)
- Trygstad CW, "Elevated serum IgA globulin in anaphylactoid purpura", Pediatrics, 47, pp.1023~1028 (1971)
- Davin JC, "What is the difference between IgA nephropathy and Henoch-Schönlein purpura nephritis?", Kidney Int, 59, pp.823~834 (2001)
- Motoyama O, "Henoch-Schonleinpurpura with hypocomplementemia in children", PediatrInt, 47, pp.39~42 (2005)
- Lin Q, "Henoch-Schönlein purpura with hypocomplementemia", PediatrNephrol, 27, pp.801~806 (2012)
- Kawana S, "Serum SC5b-9 (terminal complement complex) level, a sensitive indicator of disease activityin patients with Henoch-Schönlein purpura", Dermatology, 184, pp.171~176 (1992)
- Smith GC, "Complement activation in Henoch-Schönlein purpura", Pediatr Nephrol, 11, pp.477~480 (1997)
- Kuźma-Mroczkowska E, "Mycoplasma pneumoniae as a trigger for Henoch-Schönlein purpura in children", Cent Eur J Immunol, 40, pp.489~492 (2015)