Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland.
Arch Dis Child. 2010 Nov;95(11):877-82. doi: 10.1136/adc.2009.182394. Epub 2010 Sep 18.
To assess the risk factors for developing Henoch-Schönlein purpura nephritis (HSN) and to determine the time period when renal involvement is unlikely after the initial disease onset.
A prospective study of 223 paediatric patients to examine renal manifestations of Henoch-Schönlein purpura (HSP). The patient's condition was monitored with five outpatient visits to the research centre and urine dipstick testing at home.
HSN occurred in 102/223 (46%) patients, consisting of isolated haematuria in 14%, isolated proteinuria in 9%, both haematuria and proteinuria in 56%, nephrotic-range proteinuria in 20% and nephrotic-nephritic syndrome in 1%. The patients who developed HSN were significantly older than those who did not (8.2±3.8 vs 6.2±3.0 years, p<0.001, CI for the difference 1.1 to 2.9). Nephritis occurred a mean of 14 days after HSP diagnosis, and within 1 month in the majority of cases. The risk of developing HSN after 2 months was 2%. Prednisone prophylaxis did not affect the timing of the appearance of nephritis. The risk factors for developing nephritis were age over 8 years at onset (OR 2.7, p=0.002, CI 1.4 to 5.1), abdominal pain (OR 2.1, p=0.017, CI 1.1 to 3.7) and recurrence of HSP disease (OR 3.1, p=0.002, CI 1.5 to 6.3). Patients with two or three risk factors developed nephritis in 63% and 87% of cases, respectively. Laboratory tests or blood pressure measurement at onset did not predict the occurrence of nephritis.
The authors recommend weekly home urine dipstick analyses for the first 2 months for patients with HSP. Patients with nephritis should be followed up for more than 6 months as well as the patients with HSP recurrence.
评估儿童过敏性紫癜肾炎（HSN）的发病风险因素，并确定疾病初始发作后肾脏受累不太可能发生的时间段。
对 223 例儿科患者进行前瞻性研究，以检查过敏性紫癜（HSP）的肾脏表现。通过五次到研究中心的门诊就诊和在家中的尿液干化学检测来监测患者的病情。
223 例患者中，102 例（46%）发生 HSN，其中孤立性血尿占 14%，孤立性蛋白尿占 9%，血尿和蛋白尿均占 56%，肾病范围蛋白尿占 20%，肾病-肾炎综合征占 1%。发生 HSN 的患者明显比未发生 HSN 的患者年龄大（8.2±3.8 岁比 6.2±3.0 岁，p<0.001，差值的置信区间为 1.1 至 2.9）。肾炎在 HSP 诊断后平均 14 天出现，多数情况下在 1 个月内出现。2 个月后发生 HSN 的风险为 2%。泼尼松预防治疗并未影响肾炎出现的时间。发生肾炎的风险因素为发病时年龄大于 8 岁（OR 2.7，p=0.002，CI 1.4 至 5.1）、腹痛（OR 2.1，p=0.017，CI 1.1 至 3.7）和 HSP 疾病复发（OR 3.1，p=0.002，CI 1.5 至 6.3）。有两个或三个风险因素的患者分别有 63%和 87%发展为肾炎。发病时的实验室检查或血压测量不能预测肾炎的发生。
作者建议 HSP 患者在最初 2 个月每周进行家庭尿液干化学检测。肾炎患者应随访超过 6 个月，同时应随访 HSP 复发的患者。
