SCHONLEIN-HENOCH PURPURA - COURSE IN 139 CHILDREN

We evaluated the records of 139 pediatric patients with Schonlein-Heno ch purpura (aged 0.4 to 15.1 years, median 5.4 years), referred from 1 974 to 1993 to the University Children's Hospital, Berne. An acute feb rile illness preceded Henoch-Schonlein purpura in 83 (60%) out of the 139 children. The purpuric papules were distributed over the lower ext remities and the buttocks in 68 patients (49%), and more extensively i n the remaining 71 (51%). Joint tenderness or swelling was observed in 110 patients (79%). Abdominal involvement occurred in 92 patients (66 %): abdominal pain (n = 63), melena or hematemesis (n = 23), and intus susception (n = 6). The following rather rare features were observed: scrotal swelling (n = 11), neurologic involvement (n = 3), and stenosi ng ureteritis (n = 1). A remission lasting at least 4 weeks occurred w ithin 4 weeks in 84, within 5-8 weeks in 19, and within 9-53 weeks in 18 out of 121 patients. A relapse was observed in 10 subjects. Renal i nvolvement occurred in 60 patients. Severe renal involvement, defined as proteinuria exceeding 40 mg/[m(2) x h], occurred in 18 of the patie nts with renal involvement. Progredient renal failure developed in one male. Children with renal involvement tended to be older (6.6 versus 4.1 years) and to have more prolonged extrarenal manifestations (6 ver sus 3 weeks). It is concluded that in children with Schonlein-Henoch p urpura extrarenal involvement often lasts more than one month. Its out come is almost always favourable. Children with heavy proteinuria tend in some cases to develop renal failure. For these patients, new treat ment regimens aimed at preventing renal failure warrant evaluation in prospective controlled studies.