ORIGINAL ARTICLE

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

Correspondence to:
Dr H Narchi
Paediatric Department, Sandwell General Hospital, West Bromwich B71 4HJ, UK; hassibnarchi{at}hotmail.com

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.

Abbreviations: ESRD, end-stage renal disease; HSP, Henoch-Schönlein purpura; NNP, nephritic or nephrotic syndrome

Keywords: purpura; schoenlein-henoch; urine; haematuria; proteinuria; prognosis

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Saulsbury, F. T. (2009). Successful Treatment of Prolonged Henoch-Schonlein Purpura With Colchicine. CLIN PEDIATR 48: 866-868  
• Chartapisak, W, Opastiraku, S L, Willis, N S, Craig, J C, Hodson, E M (2009). Prevention and treatment of renal disease in Henoch-Schonlein purpura: a systematic review. Arch. Dis. Child. 94: 132-137 [Abstract] [Full Text]  
• Maripuri, S., Fervenza, F. C. (2008). 71-Year-Old Man With Shortness of Breath and Rash. Mayo Clin Proc. 83: 1388-1391 [Full Text]  
• Gibson, K. L., Amamoo, M. A., Primack, W. A. (2008). Corticosteroid Therapy for Henoch Schonlein Purpura. Pediatrics 121: 870-871 [Full Text]  
• Tizard, E J, Hamilton-Ayres, M J J (2008). Henoch Schonlein purpura. EDUCATION AND PRACTICE 93: 1-8 [Full Text]  
• Butani, L., Morgenstern, B. Z. (2007). Long-term Outcome in Children After Henoch-Schonlein Purpura Nephritis. CLIN PEDIATR 46: 505-511 [Abstract]  
• Li, S. C. (2006). Risk Factors for the Development of Nephritis in Henoch-Schonlein Purpura. AAP Grand Rounds 16: 14-15 [Full Text]  
• Aldous, M. B., Friedman, A. L. (2005). HSP: Risk of Renal Damage & Follow-Up Recommendations. AAP Grand Rounds 14: 65-65 [Full Text]