Kupfer I, Joly P, Courville P, Balguerie X, Jouen-Beades F, Lauret P
Clinique Dermatologique, Unité INSERM 519, Hôpital Charles Nicolle, 1, rue de Germont, 76031 Rouen Cedex.
Ann Dermatol Venereol. 2000 Oct;127(10):818-21.
The aim of this study was to estimate the frequency of medium-term renal involvement, in a series of adult patients with Henoch-Schönlein purpura treated in a dermatology department.
Seventeen patients with Henoch-Schönlein purpura followed from 1991 to 1997 in the department of dermatology were included in the study. Renal tests included: research of microscopic hematuria, proteinuria, plasma creatinine levels and calculated creatinine clearance which were measured during initial hospitalization and at the date of the study in May 1998.
10 men and 7 women (mean-age 51 years) were followed up for 39 months (6 to 79 months). Initial renal involvement was observed in 11 patients (65 p. 100). A microscopic hematuria was also observed in 9 patients (53 p. 100), a proteinuria in 6 (35 p. 100), an association of hematuria and proteinuria in 4 (23.5 p. 100). No patient had renal failure. In May 1998, only 2 patients (11.7 p. 100) had renal involvement, that consisted of proteinuria: 3.3 and 3. 9 g/d respectively, with no renal failure.
The 65 p. 100 frequency of renal involvement discovered during the acute phase of HSP in our series was similar to other series mentioned in the literature, which mainly consisted of hematuria and/or proteinuria. The frequency of long-term renal involvement depends on the origin of patient recruitment. Nephrological studies have reported high levels of renal involvement, that probably overestimated the true frequency. In the present study, as well as in two other studies from a non-nephrological recruitment, the frequency of long-term renal involvement was estimated between 11 p. 100 and 16 p. 100 and was primarily persistent proteinuria.
The frequency of renal involvement in the adult patient with HSP during the acute phase of the disease and after a medium-term follow-up was approximately 50 p. 100 and between 11 p. 100 to 16 p. 100 respectively.
本研究旨在评估在皮肤科接受治疗的一系列成人过敏性紫癜患者中期肾脏受累的发生率。
本研究纳入了1991年至1997年在皮肤科就诊的17例过敏性紫癜患者。肾脏检查包括：在初次住院期间及1998年5月研究时检测镜下血尿、蛋白尿、血浆肌酐水平及计算肌酐清除率。
10例男性和7例女性（平均年龄51岁）接受了39个月（6至79个月）的随访。11例患者（65%）在疾病初期出现肾脏受累。9例患者（53%）出现镜下血尿，6例（35%）出现蛋白尿，4例（23.5%）出现血尿和蛋白尿同时存在的情况。无患者出现肾衰竭。1998年5月，仅有2例患者（11.7%）存在肾脏受累，均为蛋白尿，分别为3.3 g/d和3.9 g/d，且无肾衰竭。
我们研究系列中过敏性紫癜急性期发现的65%的肾脏受累发生率与文献中提及的其他系列相似，主要表现为血尿和/或蛋白尿。长期肾脏受累的发生率取决于患者招募来源。肾脏病学研究报告的肾脏受累水平较高，可能高估了实际发生率。在本研究以及另外两项非肾脏病学招募来源的研究中，长期肾脏受累的发生率估计在11%至16%之间，主要为持续性蛋白尿。
成年过敏性紫癜患者在疾病急性期及中期随访后的肾脏受累发生率分别约为50%和11%至16%。
