LONG-TERM PROGNOSIS OF HENOCH-SCHONLEIN NEPHRITIS IN ADULTS AND CHILDREN

Background. The aim of this multicentre collaborative study was to com pare the progression of renal disease in children and adults with Heno ch-Schonlein purpura (HPS) nephritis selected on the basis of IgA-domi nant renal deposits and biopsy material available for review. Methods. The analysis was performed in 152 patients (95 adults and 57 children < 16 years old at diagnosis) with a follow-up (greater than or equal to 1 year up to 20 years (4.9 +/- 3.4 years in adults and 4.8 +/- 3.9 years in children). Results. Renal histology and clinical presentation were similar in both age groups: crescents were found in 36% of adult s and 34.6% of children (in only 2.7% of adults and 1.9% of children i nvolving > 50% of glomeruli), nephrotic-range proteinuria in 29.5% of adults and 28.1% of children and functional impairment in 24.1% of adu lts and 36.9% of children. The outcome was similar for both age groups (remission, 32.5% of adults and 31.6% of children; renal function imp airment, 31.6% of adults and 24.5% of children). Endstage renal diseas e was observed in 15.8% of adults and in 7% of children. Renal functio n survival at 5 years was not significantly different in the two group s (85% in adults and 95% in children) and at 10 years it was approxima tely 75% in both groups. None of the children died and adult survival was 97% at 5 years. In adults at-presentation, renal function impairme nt (P<0.02) as well as proteinuria higher than 1.5 g/day (P<0.02) and hypertension (P<0.001) were negative prognostic factors. Multivariate analysis stressed the main statistical relevance of proteinuria (relat ive risk 2.37, P<0.02). Conversely, in children no definite level of p roteinuria, hypertension or other data were found to be associated wit h poor prognosis. Conclusions. Among patients with a clinical presenta tion which warrants renal biopsy, HSP nephritis has a similar prognosi s in children and adults. The evolution is more predictable in adults than in children.