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Journal of the Korean Society of Pediatric Nephrology 2003;7(2): 157-165.
소아와 성인 $Henoch-Sch""{o}nlein$ Purpura(HSP) 신염의 임상적 비교
김기은, 신윤호, 신재일, 박지민, 정현주, 이재승
1연세대학교 의과대학 소아과학교실, 신장질환연구소
2연세대학교 의과대학 소아과학교실, 신장질환연구소
3연세대학교 의과대학 소아과학교실, 신장질환연구소
4연세대학교 의과대학 소아과학교실, 신장질환연구소
5연세대학교 의과대학 병리학교실, 신장질환연구소
6연세대학교 의과대학 소아과학교실, 신장질환연구소
Clinical Comparison of $Henoch-Sch""{o}nlein$ Purpura Nephritis in Children and Adults
Ki-Eun Kim, Youn-Ho Shin, Jae-Il Shin, Jee-Min Park, Hyeon-Joo Jeong, Jae-Seung Lee
1Department of Pediatrics, College of Medicine and The Institute of Kidney Disease, Yonsei University
2Department of Pediatrics, College of Medicine and The Institute of Kidney Disease, Yonsei University
3Department of Pediatrics, College of Medicine and The Institute of Kidney Disease, Yonsei University
4Department of Pediatrics, College of Medicine and The Institute of Kidney Disease, Yonsei University
5Department of Pathology, College of Medicine and The Institute of Kidney Disease, Yonsei University
6Department of Pediatrics, College of Medicine and The Institute of Kidney Disease, Yonsei University
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ABSTRACT
Purpose : $Henoch-Sch""{o}nlein$ purpura(HSP) is a systemic vasculitis that involves multiple organs, especially the kidney, which is the most important organ in determining the prognosis of the disease. The morbidity of HSP nephritis in adults is low and there have been little research done on its clinical course so far. Therefore, we have compared the clinical course of HSP nephritis in children and adults in Korea.
Methods : We retrospectively analyzed 81 cases of HSP nephritis in children younger than 15 years of age, and 25 cases of adults older than 15 years of age who were admitted to Yonsei University Medical College Severance Hospital from Jan. 1986 to May 2003.
Results : The male to female ratio was 1.5 : 1 in children and 1.3 : 1 in adults. The incidence of HSP nephritis for both age groups was found to be increased during the autumn and winter. Infection was the predisposing factor in 39 cases(48.1%) of children, 16 cases(64.0%) of adults, and drugs were the predisposing factor in 8 cases(9.9%) of children and 4 cases (16.0%) of adults. All patients initially presented with microscopic hematuria. Thirteen cases (16.0%) of children and 7 cases(28.0%) of adults initially showed proteinuria of nephrotic range. Thirty four cases(42.0%) of children and 4 cases(16.0%) of adults showed normal urinalysis after treatment. Asymptomatic urinary abnormalities were found in 41 cases(50.6%) of children and 18 cases(72.0%) of adults. Complications such as nephrotic syndrome and hypertension were found in 3 cases(3.7%) of children and 2 cases(8.0%) of adults. Three children(3.7%) and 1(4.0%) adult required dialysis or renal transplantation. Follow-up renal biopsies were performed on 21 children, of whom 10 cases(47.6%) did not show any histologic change, 9 cases(42.9%) showed low grade changes, and 2 cases(9.5%) showed high grade changes. Prognosis was gloomy when proteinuria of nephrotic range and high grade of abnormal histology were present at diagnosis, and there was no significant difference between the two groups(P<0.05)
Conclusion : This study showed that there was no difference in terms of the clinical features and courses between the children and adults with HSP nephritis. Proteinuria of nephrotic range and the severity of abnormal histologic changes at diagnosis were found to be associated with a bad prognosis, therefore we recommend that patients with these features require long term follow-up and management.
Key words: $Henoch-Sch\""{o}nlein$ purpura nephritis | Adult | Children | Prognosis
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