41. Renal involvement in adult patients with Schonlein-Henoch purpura: Report of two cases and literature review
Main Article Content
Abstract
Schonlein -Henoch Purpura (HSP) is a systemic small-vessel vasculitis that is responsible for multi-organ damage with the classic tetralogy, including: non-thrombocytopenic purpura, abdominal pain, arthritis, and renal involvement. The disease is common in children (> 90% of cases) while the incidence in adults is only about 3.4 - 14.3/1,000,000 cases. Although much rarer in adulthood, it is associated with an increased risk of severe kidney involvement and prolonged hospital stay. We report 2 cases of adult patients with onset of HSP diagnosed at Bach Mai Hospital. Renal damage was noted in both cases. Renal biopsy results in both cases showed mesangial proliferation and IgA deposition in the mesangium. In this report, we provide information on clinical and paraclinical characteristics and biopsy results of renal lesions of both patients, and review the literature to predict and manage cases of adult-onset HSP with renal involvement.
Article Details
Keywords
Schonlein-Henoch Purpura (HSP), renal involvement, cases report
References
2. Davin JC, Ten Berge IJ, Weening JJ. What is the difference between IgA nephropathy and Henoch-Schönlein purpura nephritis? Kidney Int. 2001; 59(3): 823-834. doi:10.1046/j.1523-1755.2001.059003823.x.
3. Davin JC. Henoch-Schonlein purpura nephritis: pathophysiology, treatment, and future strategy. Clin J Am Soc Nephrol. 2011; 6(3): 679-689. doi:10.2215/CJN.06710810.
4. Rovin BH, Adler SG, Barratt J, et al. Executive summary of the KDIGO 2021 Guideline for the Management of Glomerular Diseases. Kidney Int. 2021; 100(4): 753-779. doi:10.1016/j.kint.2021.05.015.
5. Audemard-Verger A, Pillebout E, Guillevin L, Thervet E, Terrier B. IgA vasculitis (Henoch-Shönlein purpura) in adults: Diagnostic and therapeutic aspects. Autoimmun Rev. 2015; 14(7): 579-585. doi:10.1016/j.autrev.2015.02.003.
6. González-Gay MA, López-Mejías R, Pina T, Blanco R, Castañeda S. IgA Vasculitis: Genetics and Clinical and Therapeutic Management. Curr Rheumatol Rep. 2018; 20(5): 24. doi:10.1007/s11926-018-0735-3.
7. Hetland LE, Susrud KS, Lindahl KH, Bygum A. Henoch-Schönlein Purpura: A Literature Review. Acta Derm Venereol. 2017; 97(10): 1160-1166. doi:10.2340/00015555-2733.
8. Ozen S, Pistorio A, Iusan SM, et al. EULAR/PRINTO/PRES criteria for Henoch–Schönlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II: Final classification criteria. Annals of the Rheumatic Diseases. 2010; 69(5): 798-806. doi:10.1136/ard.2009.116657.
9. Gharavi AG, Kiryluk K, Choi M, et al. Genome-wide association study identifies susceptibility loci for IgA nephropathy. Nat Genet. 2011; 43(4): 321-327. doi:10.1038/ng.787.
10. Bluman J, Goldman RD. Henoch-Schönlein purpura in children: limited benefit of corticosteroids. Can Fam Physician. 2014; 60(11): 1007-1010.