Henoch-Schönlein Purpura from the Standpoint of Preventive Corticoid Administration

Czech version

Authors: M. Jeseňák; M. Antonyová; M. Brndiarová; J. Buchanec; P. Bánovčin
Authors‘ workplace: Klinika detí a dorastu, Univerzita Komenského v Bratislave, Jesseniova lekárska fakulta a Martinská fakultná nemocnica, Martin prednosta prof. MUDr. P. Bánovčin, CSc.
Published in: Čes-slov Pediat 2008; 63 (10): 557-564.
Category: Review

Overview

Henoch-Schönlein purpura (HSP) is the most frequent vasculitis of the child age, with 75% of the affected patients diagnosed at the age of 2 to 11 years. HSP is the IgA-mediated autoimmune, non-thrombocytopenic, a systemic, leukocytoclastic and hypersensitive vasculitis of predominantly child age, affecting small vessels of the skin, joints, gastrointestinal tract and kidneys.

It is clinically characterized of classical triad of symptoms:
skin rash (purpura), abdominal pain, and possibly renal affection and arthritis. HSP may occur also at the adult age and the nosological unit should be considered especially in combination of skin symptoms and abdominal pain resembling abdominal emergency. There is no specific therapy of HSP. A long-term topic of discussion is the administration of corticoids from the point of view of prevention of subsequent renal affection and its progression.

Key words:
Henoch-Schönlein purpura, corticoids, renal affection, vasculitis

Sources

1. Buchanec J, Minárik J. Purpura Schönlein-Henoch. In: Buchanec J, et al. Vademékum pediatra. Martin: Osveta, 2001: 1115.

2. Miller ML, Pachman LM. Henoch-Schönlein purpura. In: Behrman E, Kliegman RM, Jenson HB. Nelson Textbook of Pediatrics. 17th ed. New York: W.B. Saunders Copany, 2004.

3. Williams DG. Pathogenesis of idiopathic IgA nephropathy. Pediatr. Nephrol. 1993;7: 303–311.

4. Allen AC, Willis FR, Beattie TJ, et al. Abnormal IgA glycosylation in Henoch-Schönlein purpura restricted to patients with clinical nephritis. Nephrol. Dial. Transplant. 1998;13: 930–934.

5. Lin J-J, Stewart CL, Kaskel FJ, et al. IgG a IgA classes of antineutrophil cytoplasmatic antibodies in a 13 year old girl with reccurent Henoch-Schönlein purpura. Pediatr. Nephrol. 1993;7: 143–146.

6. Ronda N, Esnault VLM, Layward L, et al. Antineutrophil cytoplasmatic antibodies (ANCA) of IgA izotype in adult Henoch-Schönlein purpura. Clin. Exp. Immunol. 1994;95: 49–55.

7. Saulsbury FT. The role of IgA, rheumatoid factor in the formation of IgA-containing immune complexes in Henoch-Schönlein purpura. J. Clin. Lab. Immunol. 1987;23: 123–127.

8. Saulsbury FT. Henoch-Schönlein purpura in children: Report of 100 patients and review of the literature. Medicine (Baltimore) 1999;78: 395–409.

9. Tizard EJ. Henoch-Schönlein purpura. Arch. Dis. Child. 1999;80: 380–383.

10. Davin JC, Pierard G, Dechenne C, et al. Possible role of IgE in Henoch-Schönlein purpura. Pediatr. Nephrol. 1994;8: 169–171.

11. Saulsbury FT. Henoch-Schönlein purpura [Vasculitis syndromes]. Curr. Opin. Rheumatol. 2001;13: 35–40.

12. Buchanec J, Zibolen M. Naše skúsenosti s prevenciou vzniku nefropatie pri Schönleinovej-Henochovej purpure včasným podaním prednisonu. Aktual. Nefrol. 1998;4: 24–25.

13. Crowson AN, Mihm MC, Magro CM. Cutaneous vasculitis: a review. J. Cutan. Pathol. 2003;30: 161–173.

14. Magro CM, Crowson AN. A clinical and histologic study of 37 cases of immunoglobulin A-associated vasculitis. Am. J. Dermatopathol. 1999;21: 234–240.

15. Pertuiset E, Lioté F, Launay-Russ E, et al. Adult Henoch-Schönlein purpura associated with malignancy. Semin. Arthritis Rheum. 2000;29: 360–367.

16. Rostoker G. Schönlein-Henoch purpura in children and adults: diagnosis, pathophysiology and management. BioDrugs. 2001;15(2): 99–138.

17. Sinha A, Sood J, Kumra VP. Henoch-Schönlein purpura and anaesthesia – a case report. Indian J. Anaesth. 2005;49: 47–48.

18. Hughes FJ, Wolfish NM, McLaine PN. Henoch-Schönlein syndrome and IgA nephropathy: a case report suggesting a common pathogenesis. Pediatr. Nephrol. 1988;2: 389–392.

19. Neilsen HE. Epidemiology of Schönlein-Henoch purpura. Acta Paediatr. 1988;77: 125–131.

20. Robson WLM, Leung AKC. Henoch-Schönlein purpura. Adv. Pediatr. 1994;41: 163–194.

21. Al-Sheyyab M, El-Shanti H, Ajlouni S, et al. The clinical spectrum of Henoch-Schönlein purpura in infants and young children. Eur. J. Pediatr. 1995;154: 969–972.

22. Olson JC, Kelly K, Pan CG, et al. Pulmonary disease with hemorrhage in Henoch-Schönlein purpura. Pediatrics 1992;89: 1177–1181.

23. Verrina E, Perfumo F, Canepa A, et al. Clinical aspects of the nephropathy in Schoenlein-Henoch syndrome. Pediatr. Med. Chir. 1986;8: 317–320.

24. Mills JA, Michel BA, Bloch DA, et al. The American College of Rheumatology 1990 criteria for the classification of Henoch-Schönlein purpura. Arthritis Rheum. 1990;33: 1114–1121.

25. Ruellan A, Khatibi M, Staub T, et al. Rheumatoid purpura and intravenous immunoglobulins. Rev. Med. Intern. 1997;18: 727–729.

26. Niaudet P, Murcia I, Beaufils H, et al. Primary IgA nephropathies in children: prognosis and treatment. Adv. Nephrol. 1993;22: 121–140.

27. Oner A, Tinaztepe K, Erdogan O. The effect of tripple therapy on rapidly progressive type of Henoch-Schönlein nephritis. Pediatr. Nephrol. 1995;9: 6–10.

28. Belovezhdov N. Treatment of diffuse glomerulonephritis in adults with Schönlein-Henoch disease using a combination of anticoagulants, corticosteroids and immunosuppressants. Vutr. Boles. 1986;25: 21–25.

29. Meulders Q, Pirson Y, Cosyns J-P, et al. Course of Henoch-Schönlein nephritis after renal transplantation. Transplant. 1994;58: 1179–1186.

30. Blanco R, Martinez-Taboada VM, Rodruguez-Valverde V, et al. Henoch-Schönlein purpura in adulthood and children: two different expessions of the same syndrome. Arthritis Rheum. 1997;40: 438–442.

31. Kaku Y, Nohara K, Honda S. Renal involvement in Henoch-Schönlein purpura: a multivariate analysis of prognostic factors. Kidney Int. 1998;53: 1755–1759.

32. Meadow SR. The prognosis of Henoch Schönlein nephritis. Clin. Nephrol. 1978;9: 87–90.

33. Saulsbury FT. Corticoid therapy does not prevent nephritis in Henoch-Schönlein purpura. Pediatr. Nephrol. 1993;7: 69–71.

34. Stewart M, Savage JM, Bell B, et al. Long-term renal prognosis of Schönlein-Henoch purpura in an unselected childhood population. Eur. J. Pediatr. 1988;147: 113–115.

35. Loirat C, Ehrich JHH, Geerlings W, et al. Report on management of renal failure in children in Europe, 1992. Nephrol. Dial. Transplant. 1994;9: 26-40.

36. Schärer K, Krman R, Querfeld U, et al. Clinical outcome of Schönlein-Henoch nephritis in children. Pediatr. Nephrol. 1999;13: 816–823.

37. Goldstein AR, White RHR, Akuse R, et al. Long-term follow-up of childhood Henoch-Schönlein nephritis. Lancet 1992;1: 280–282.

38. Ronkainen J, Nuutinen M, Kosomies O. The adult kidney 24 years after childhood Henoch-Schönlein purpura: a retrospective cohort study. Lancet 2002;360: 666–670.

39. Koskimes O, Mir S, Rapola J, et al. Henoch-Schönlein nephritis: long-term prognosis of unselected childhood population. Arch. Dis. Child. 1981;56: 482–484.

40. Kapoor A, Mowbray JF, Porter KA, et al. Significance of haematuria in hypertensive patients. Lancet 1980;1: 231–232.

41. Pillebout E. Thervet E, Hill, et al. Henoch-Schönlein purpura in adults: outcome and prognostic factors. J. Am. Soc. Nephrol. 2002;13: 1271–1278.

42. Thervet E, Pillebout E, Guillevin L. Outcome after childhood Henoch-Schönlein purpura. Lancet 2003;361: 81.

43. Coppo R, Mazzucco G, Cagnoli L, et al. Long-term prognosis of Henoch-Schönlein nephritis in adults and children. Nephrol. Dial. Transplant. 1997;12: 2277–2283.

44. Buchanec J, Minárik M. Jak léčit Schoenleinovu (Schönleinovu)-Henochovu anafylaktoidnú purpuru? [Dotazy a odpovědi]. Čes.-slov. Pediat. 2000;55: 478–480.

45. Reinehr T, Burk G, Werner A. Does steroid treatment of abdominal pain prevent renal involvement in Henoch-Schönlein purpura? J. Pediatr. Gastroenterol. Nutr. 2000;31: 323–325.

46. Mollica F, Li Volti S, Garozzo R, et al. Effectiveness of early prednisone therapy in preventing the development of nephropathy in anaphylactoid purpura. Eur. J. Pediatr. 1992;151: 140–144.

47. Buchanec J, Galanda V, Belakova S, et al. Incidence of renal complications in Schoenlein-Henoch purpura syndrome in dependence of an early administration of steroids. Int. Urol. Nephrol. 1988;20: 409–412.

48. Buchanec J, Galanda V, Belaková S, et al. Možno zabrániť nefropatii pri Schoenleinovej purpure včasným podaním prednisonu? Čes.-slov. Pediat. 1989;44: 145–146.

49. Buchanec J, Zibolen M, Hyrdelová E, et al. Možná prevencia vzniku nefropatie pri Schoenlein-Henochovej purpure včasným podaním prednisonu – dôvody pre a proti. Čes.-slov. Pediat. 1998;53: 256–259.

50. Reinehr T, Burk G, Berger T, et al. Steroids for prophylaxis of nephropathy in Schönlein-Henoch purpura? Follow-up of 171 patients. Klin. Pädiatr. 2000;212: 99–102.

51. Szelid Z, Bereczky J, Nagymanyai Z, et al. Heparin prophylaxis of Henoch-Schoenlein nephropathy. Acta. Paediatr. Hung. 1986;27: 57–60.

52. Bona G, Monti G. Schönlein-Henoch syndrome in children. Clinico-epidemiological analysis of 170 cases. Minerva Pediatr. 1989;41: 587–592.

53. Huber AM, King J, McLaine P, et al. A randomized, placebo controlled trial of prednisone in early Henoch-Schönlein purpura. BMC Med. 2004;2: 7–14.

54. Counahan R, Winterborn MH, White RHR, et al. Prognosis of Henoch-Schönlein nephritis in children. Brit. Med. J. 1977;2: 11–14.

55. Sano H, Izumida M, Shimizu H, et al. Risk factors for renal involvement and significant proteinuria in Henoch-Schönlein purpura. Eur. J. Pediatr. 2002;161: 196–201.

56. Temmel AFP, Emminger W, Schroth B, et al. Early prednisone therapy and nephropathy in anaphylactoid purpura. Eur. J. Pediatr. 1993;152: 782–783.

57. Feber J, Dušek J, Janda J. Preventivní podání kortikoidu u Henoch-Schoenleinovy purpury. In Jurko A, et al. Diagnostika a terapia v pediatrii III. Martin: JLF UK, 1996: 41–42.