Henoch-Schonlein Nephritis in Adults: Renal Outcomes and Prognostic Factors

Kim, Nan Hee; Ham, Young Rok; Yoon, Ji Hyun; Jung, Ji Yoon; Kim, Eui Sik; Chung, Sarah; Choi, Dae Eun; Na, Ki Ryang; Lee, Kang Wook; Shin, Young Tai

Abstract

PURPOSE
Renal involvement of Henoch-Schonlein (HS) purpura is common, and the long-term prognosis depends on the degree of renal injury. The aim of our study was to search for prognostic factors of HS nephritis and its relationship with clinical, laboratory, and renal pathologic features.
METHODS
Study population consisted of 81 patients (age > or =15 years) with HS nephritis who had been admitted to Chungnam National University Hospital from January, 1991 to February, 2008. We reviewed the clinical symptoms, laboratory data and pathologic findings of kidney of total 81 patients, and also analyzed the relationship between these and renal prognosis.
RESULTS
The mean age of patients was 40.6 years and the median duration of follow-up was 16 months. Male to female ratio was 1.08. Kidney biopsies were carried out in 61 patients (75.4%). Regarding renal function, 14 (17.3%) of patients reached moderate to severe renal insufficiency, and 4 (4.9%) progressed to end-stage renal disease within 16 months (median, range 1.5-196 months) after diagnosis. Complete clinical remission was achieved in 26 patients (32.1%). The presence of gastrointestinal symptoms, relapse of purpura, hypertension, nephrotic syndrome, renal insufficiency, increased level of serum immunoglobulin A, and the magnitude of crescents and sclerotic glomeruli were significantly associated with poor renal prognosis (all p<0.05). In multivariate logistic regression analysis, initial elevated serum creatinine level and hypertension were independent prognostic factors (p=0.013, p=0.007).
CONCLUSION
We concluded that the initial clinical findings including renal function and hypertension are important prognostic factors in adult HS nephritis.