Henoch-Schonlein purpura after 20 years of renal replacement therapy

While the clinical impact of the impaired immune response, commonly describ ed in chronic dialysis patients, is still a matter of discussion, it is usu ally considered that immunological diseases tend to become progressively le ss active after the start of regular renal replacement therapy (RRT). We re ported a case of Henoch-Schonlein Purpura in a 51-year-old male, on RRT for 20 years, 8 on dialysis and 12 with renal graft, because of ESRD of unknow n origin (chronic glomerulonephritis?). The acute onset of the syndrome, pr esenting purpuric rash, abdominal discomfort and asymmetric joint pain with edema and local signs of acute inflammation, was followed by several relap ses over a 2 years period. This biopsy proven diagnosis offered an explanat ion for his chronic renal failure; furthermore, we conclude that, possibly because of the usually good correction of uremic immunodepression by effici ent dialysis (this patient's Kt/V ranged from 1.1 to 1.3 according to Lowri e's formula), the possibility of immune diseases should be carefully consid ered even in long long-term RRT patients.