Ulcerated lesions as a risk factor for Henoch-Schonlein purpura nephritis

Abstract

Objective: To determine the correlation between the severity of Henoch-Schonlein purpura skin manifestations and development of nephritis and to characterise the disease within the Maltese paediatric population. --

Design: A retrospective analysis of the 96 cases diagnosed with Henoch-Schonlein purpura at Mater Dei Hospital between January 2008 and January 2016. Clinical notes were reviewed and anonymised data regarding the presentation, progression and follow-up of these cases was entered into a database. --

Results: 96 cases met the inclusion criteria with a male to female ratio of 1.35:1 and with a mean age at presentation of 6.4 years (interquartile range 3.5 years). 99% had the typical rash at presentation with 75% having other associated clinical findings. Renal involvement was found in 36.5%: isolated proteinuria in 19.8%, isolated haematuria in 13.5%, haematuria, proteinuria and hypertension in 3.1% and nephrotic range proteinuria in 2% of cases. A severe rash at presentation was shown to be a prognostic indicator for renal involvement. --

Conclusion: Henoch-Schonlein purpura in the Maltese paediatric population is similar in incidence to that quoted in the literature. The majority of cases are uncomplicated and the outcome is frequently favourable. The presence of a severe rash at presentation significantly increases the risk of renal involvement and long term complications.