Long-term follow-up of childhood Henoch-Sch�nlein nephritis

Goldstein, Amanda; White, Richard; Akuse, Rosamund; Chantler, C

doi:10.1007/bf00869746

Cited by 16 publications

(31 citation statements)

References 16 publications

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“…The latter is suggested by several reports of HSPN observed in patients known to have had IgAN for many years (82)(83)(84)(85). In general, there is a good relationship between the severity of initial clinical presentation and the risk of CKD at long term (14,21) (Table 1), but it is far from being a constant rule.…”

Section: Prognostic Value Of Renal Symptomsmentioning

confidence: 90%

“…Parallel to this change and despite the lack of evidence-based data, recommended treatments in text books changed from supportive measures (77)(78)(79) to the use of steroids and immunosuppressive drugs (80,81) even in the absence of a picture of rapidly progressive glomerulonephritis (80). Another difficulty resides in the development of CKD up to 20 years after disease initiation, especially during pregnancy, even after complete apparent resolution (14,21). This implies that only series with sufficient follow-up might be informative.…”

Section: Prognostic Value Of Renal Symptomsmentioning

confidence: 99%

“…It is remarkable that some (rare) patients presenting with mild initial symptoms are seen with CKD at long term (14,86). A particular example is CKD observed after repeated episodes of isolated macroscopic hematuria (87,88).…”

Section: Prognostic Value Of Renal Symptomsmentioning

confidence: 99%

“…In one study using a cohort of adult patients in whom the diagnosis was based on the findings of the characteristic leucocytoclastic skin vasculitis accompanied by IgA deposits (13), 49% of patients presented with abnormal urinary signs. In selected series, HSPN leads to chronic kidney disease (CKD) 20 years after the diagnosis in up to 20% of children (14), whereas this percentage falls to less than 5% in unselected series (15). The risk of CKD in adults is higher.…”

Section: Introductionmentioning

confidence: 99%

“…Randomized clinical trials (RCTs) are scarce and often inconclusive. Spontaneous complete recovery in patients with severe initial presentation and/or extended histologic lesions and the late evolution to CKD of patients with mild initial symptoms makes the interpretation of treatment efficacy difficult (12,14,21). The main goal of the present paper is to propose a strategy aimed to better define patients at risk, using renal symptoms, histologic lesions, and possible new markers of progression to assist clinicians and clinical-trial designers to reach therapeutic decisions.…”

Section: Introductionmentioning

confidence: 99%

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Henoch-Schönlein Purpura Nephritis

Davin¹

2011

Clinical Journal of the American Society of Nephrology

148

123

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SummaryHenoch-Schö nlein purpura nephritis is a rare kidney disease leading to chronic kidney disease in a non-negligible percentage of patients. Although retrospective studies suggest beneficial effects of some therapies, prospective randomized clinical trials proving treatment efficacy are still lacking. The dilemma of spontaneous recovery even in patients with severe clinical and histologic presentation and of late evolution to chronic kidney disease in patients with mild initial symptoms renders it difficult for clinicians to expose patients to treatment protocols that are not evidence-based. A better understanding of the pathophysiology of progression to chronic kidney disease in Henoch-Schö nlein purpura patients could be achieved by designing prospective international multicenter studies looking at determinants of clinical and histopathological evolution as well as possible circulating and urinary markers of progression. Such studies should be supported by a database available on the web and a new histologic classification of kidney lesions. This paper reports clinical, pathologic, and experimental data to be used for this strategy and to assist clinicians and clinical trial designers to reach therapeutic decisions.

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