Henoch-Schonlein Purpura Nephritis in Libyan Children; Single Center Experience

Background: Henoch-Schönlein (HSP) is one of the most common vasculitis in children, it is manifested by skin purpura, arthritis, abdominal pain and renal involvement. Typically HSP is considered as self-limiting, benign condition, although renal involvement (HSP nephritis, HSN)is the principle cause of morbidity in this disease.

Aim of the study: To evaluate renal involvement in patient with HSP and to identify factors that are predictive of nephritis based on demographic data, clinical characteristics, and treatment given to those patients and to determine the follow-up time needed for diagnosing HSN patients.

Study design: retrospective descriptive analytic study.

Patients and methods: medical files of 75 children who diagnosed as HSP from January 2005 to June 2017 and were followed up in rheumatology and nephrology clinics at Tripoli Children Hospital were reviewed. For all patients included in the study, we collect the following data: Age, gender, clinical examination at presentation, laboratory data including complete blood count, C reactive protein, ESR, and complete urinalysis at presentation, also we follow the results of urinalysis for up to one year after presentation.

Results: A total of 75 patients with a HSP were enrolled in the study. Of these 40 were boys giving a male to female ratio of 1.14: 1.The mean age of onset was 6.5 ± 1.5 years (range of 2 -12 years), with most cases (93.4%) occurred in those aged less than 10 years old. HSN was the 3rd most common manifestations of HSP in our study preceded by rash in 100% of patients and gastrointestinal manifestations in 65%. HSN occurred in 30\75 of cases (40%).The most common HSN manifestations was microscopic hematuria and proteinuria in 10.7% of patients followed by microscopic hematuria in 8% of patients, isolated hypertension in 5.3% of patients. In other 5.3% of patients hypertension was associated with gross hematuria, table2. We evaluated the relationship between HSN and various factors using a univariate analysis as shown in table3, we noticed that there was no significant statistical difference between patients with and without HSN in terms of sex, gender, presence of severe abdominal pain and arthritis. 93.3% of patients with HSNmanifest within 6 weeks of disease onset and only 2 patients developed their renal involvement months later. Figure3.

Conclusion: HSN occurred in 40% of patients with HSP with 28 out of 30 who developed HSN(93.3%) developing within the initial 6 weeks of the disease. None of the studied factors were associated with higher risk of HSN by univariate statistical analysis.

Keywords: henoch-schoolen purpura, children, nephritis.