Henoch-Schönlein purpura natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Prognosis
Recovery and recurrence
Overall prognosis is good in most patients, with one study showing recovery occurring in 94% and 89% of children and adults, respectively (some having needed treatment).[1]
In children, the condition recurs in about a third of all cases and usually within the first four months after the initial attack.[2] Recurrence is more common in older children and adults.[3]
Kidney involvement
In adults, kidney involvement progresses to ESRD more often; in a UK series of 37 patients, 10 (27%) progressed to advanced kidney disease; proteinuria, hypertension at presentation, and pathology features (crescentic changes, interstitial fibrosis and tubular atrophy) predicted progression.[4]
The findings on renal biopsy correlates with the severity of symptoms: asymptomatic hematuria may only have focal mesangial proliferation while those with proteinuria may have marked cellular proliferation or even crescent formation. The number of crescentic glomeruli is an important prognostic factor in determining whether the patient will develop chronic renal disease or end-stage renal disease.[3]
In end-stage renal disease, some progress to hemodialysis or equivalent renal replacement therapy (RRT). If a kidney transplant is found for a patient on RRT, there is a risk of about 35% over 5 years that the disease will recur in the graft (transplanted kidney), and 11% that the graft will fail completely (requiring resumption of the RRT and a further transplant).[5]
References
- ↑ Blanco R, Martínez-Taboada VM, Rodríguez-Valverde V, García-Fuentes M, González-Gay MA (1997). "Henoch-Schönlein purpura in adulthood and childhood: two different expressions of the same syndrome". Arthritis Rheum. 40 (5): 859–64. doi:10.1002/1529-0131(199705)40:5<859::AID-ART12>3.0.CO;2-J. PMID 9153547.
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