Clinical Outcomes in Children Admitted with Henoch-Schönlein Purpura

Background: Henoch–Schönlein purpura (HSP) is the most common form of systemic vasculitis in small vessels in children. Renal involvement is more prevalent in older children and long-term follow-up of these patients is required.

Objective: To describe a population of children diagnosed with HSP (first onset or relapse) according to demographic data, clinical data, management and outcomes.

Methods: Retrospective analysis from medical files of HSP patients under 18 years who were admitted to paediatric emergency care and paediatric inpatient unit between 2008 and 2018.

Results: A total of thirty-nine children with HSP were analysed. Their median age was 6 years. At onset, purpura was present in all cases, arthritis/arthralgia in 87%, abdominal pain in 38%, renal involvement in 15,4% and testicular oedema in four patients. 12,8% presented with hypertension. All the patients were submitted to urine dipstick testing: four had isolated haematuria and two had both macroscopic haematuria and nephrotic proteinuria. 58,9% of the patients needed hospitalization due to renal, gastrointestinal or severe joint involvement. Treatment with steroids was given to 48,7% of the patients and about 12,8% needed antihypertensive medication. During follow-up: three patients had haematuria and nephrotic proteinuria, two had isolated nephrotic proteinuria and two had isolated haematuria; one underwent renal biopsy due to persistent haematuria and nephrotic proteinuria. 69,2% of the patients experienced no relapse, 17,9% had one relapse and five patients had ≥ 2 relapses. None developed end-stage renal disease until now.

Conclusions: The outcomes of children with HSP are generally excellent and recover spontaneously without medication, however in our cohort most of the children had renal, gastrointestinal or severe joint involvement that required hospitalization. Although the literature describes worse renal outcomes and more relapses in patients with nephrotic-range proteinuria and gross haematuria at the onset, our patients had a good prognosis.