Henoch-Schönlein purpura natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Henoch-Schönlein purpura is a self-limiting illness in the majority of patients but can rarely lead to complications such as proteinuria, End Stage Renal Disease, myocardial infarction, pulmonary hemorrhage, pleural effusion, intussusception, orchitis, GI bleeding, bowel infarction, seizures, neuropathies. The prognosis is usually good but rarely its worse in adults with renal involvement.
Natural History
- The natural history of HSP is as follows:[1][2][3][4][5][6][7]
- Henoch-Schönlein purpura is a self-limiting illness in the majority of patients.
- The abdominal and joint pain may be debilitating, and steroids have been used with some success in relieving the abdominal pain.
- The vasculitis of the gastrointestinal tract causes significant blood loss and occasionally leading to bowel ischemia, which may necessitate bowel resection.
- There is no clear evidence that remedy alters the progression of the HSP, however, the significant long-term morbidity related to the renal disease that has led to trials of steroids and other immunosuppressive drugs.
Complications
The complications of the HSP are as follows:[1][2][3][4][5][6][7]
- Renal involvement- Proteinuria, End Stage Renal Disease in 1% of patients.
- Other complications
- Myocardial infarction
- Pulmonary hemorrhage
- Pleural effusion
- Intussusception of both small and large intestines
- Orchitis
- GI bleeding
- Bowel infarction
- Seizures
- Neuropathies.
Prognosis
- The prognosis of the HSP:[8][2][9][10][11][12]
- Henoch-Schönlein purpura is an acute self-limited illness, can seldom cause complications.
- Initial attacks of HSP can last for several months. One in every four patients will have one or more recurrences.
- HSP is more benign, short course and less recurrent in children less than three years.
- CKD can progress more than 10 years after the initial HSP attack.
- The long-term prognosis of HSP depends on the extent of the kidney involvement.
- Renal involvement of more common and the prognosis is worst in adults with HSP than the children.
References
- ↑ 1.0 1.1 Scheller F, Jänchen M, Lampe J, Prümke HJ, Blanck J, Palecek E, Chow YW, Pietranico R, Mukerji A, Reynolds CH (November 1975). "Studies on electron transfer between mercury electrode and hemoprotein". Biochim. Biophys. Acta. 412 (1): 157–67. PMID 79.
- ↑ 2.0 2.1 2.2 Trnka P (December 2013). "Henoch-Schönlein purpura in children". J Paediatr Child Health. 49 (12): 995–1003. doi:10.1111/jpc.12403. PMID 24134307.
- ↑ 3.0 3.1 Kanaan N, Mourad G, Thervet E, Peeters P, Hourmant M, Vanrenterghem Y, De Meyer M, Mourad M, Maréchal C, Goffin E, Pirson Y (July 2011). "Recurrence and graft loss after kidney transplantation for henoch-schonlein purpura nephritis: a multicenter analysis". Clin J Am Soc Nephrol. 6 (7): 1768–72. doi:10.2215/CJN.00520111. PMID 21734091.
- ↑ 4.0 4.1 Samuel JP, Bell CS, Molony DA, Braun MC (August 2011). "Long-term outcome of renal transplantation patients with Henoch-Schonlein purpura". Clin J Am Soc Nephrol. 6 (8): 2034–40. doi:10.2215/CJN.01410211. PMC 3359547. PMID 21700827.
- ↑ 5.0 5.1 Poterucha TJ, Wetter DA, Grande JP, Gibson LE, Camilleri MJ, Lohse CM (July 2014). "A retrospective comparison of skin and renal direct immunofluorescence findings in patients with glomerulonephritis in adult Henoch-Schönlein purpura". J. Cutan. Pathol. 41 (7): 582–7. PMID 25097917.
- ↑ 6.0 6.1 D'Souza S, Hageman JR, Patel P, Littlejohn E (March 2014). "Henoch-Schöenlein purpura and diabetes mellitus in a 9-year-old African-American male". Pediatr Ann. 43 (3): e61–4. doi:10.3928/00904481-20140221-09. PMID 24605861.
- ↑ 7.0 7.1 Pohl M (February 2015). "Henoch-Schönlein purpura nephritis". Pediatr. Nephrol. 30 (2): 245–52. doi:10.1007/s00467-014-2815-6. PMID 24733586.
- ↑ Pillebout E, Verine J (June 2014). "[Henoch-Schönlein purpura in the adult]". Rev Med Interne (in French). 35 (6): 372–81. doi:10.1016/j.revmed.2013.12.004. PMID 24657040.
- ↑ Davin JC, Coppo R (October 2014). "Henoch-Schönlein purpura nephritis in children". Nat Rev Nephrol. 10 (10): 563–73. doi:10.1038/nrneph.2014.126. PMID 25072122.
- ↑ Kawasaki Y, Ono A, Ohara S, Suzuki Y, Suyama K, Suzuki J, Hosoya M (2013). "Henoch-Schönlein purpura nephritis in childhood: pathogenesis, prognostic factors and treatment". Fukushima J Med Sci. 59 (1): 15–26. PMID 23842510.
- ↑ Kang Y, Park JS, Ha YJ, Kang MI, Park HJ, Lee SW, Lee SK, Park YB (February 2014). "Differences in clinical manifestations and outcomes between adult and child patients with Henoch-Schönlein purpura". J. Korean Med. Sci. 29 (2): 198–203. doi:10.3346/jkms.2014.29.2.198. PMC 3923997. PMID 24550645.
- ↑ Davin JC (March 2011). "Henoch-Schonlein purpura nephritis: pathophysiology, treatment, and future strategy". Clin J Am Soc Nephrol. 6 (3): 679–89. doi:10.2215/CJN.06710810. PMID 21393485.