Adult Henoch–Schönlein purpura: Clinical and histopathological predictors of systemic disease and profound renal disease

Ruoxi Cao, Sandra Lau, Virlynn Tan, Hong Liang Tey

Indian Journal of Dermatology, Venereology, and Leprology 2017 83(5):577-582

Background: A major challenge in the management of adult Henoch–Schönlein purpura is the difficulty in assessing the risk of systemic involvement. There is currently a paucity of data in this area. Aims: This study sought to determine specific clinical and histopathological features associated with systemic involvement in adult Henoch–Schönlein purpura. Methods: We reviewed the records of 99 adult Henoch–Schönlein purpura patients who presented at the National Skin Centre, Singapore, between January 2008 and May 2015. Results: Renal involvement was found in 56 (56.6%) patients, joint involvement in 21 (21.2%) and gastrointestinal involvement in 13 (13.1%). Age > 30 years was an independent predictor of renal involvement with an adjusted odds ratio of 2.97 (95% confidence interval, 1.08–8.16; P = 0.04). Risk factors for significant renal involvement necessitating nephrology referral were further evaluated: the odds were approximately 60% higher for every 10-year increase in age (95% confidence interval, 1.02–2.57; P = 0.04) and patients with cutaneous bullae and/or necrosis had an almost six times higher risk (95% confidence interval, 1.43–25.00; P = 0.01). Limitations: This study was limited by its retrospective design. We also lacked long-term data to examine how clinical and histopathological characteristics correlated with long-term disease outcomes. Conclusions: Adult Henoch–Schönlein purpura patients older than 30 years have a threefold increased risk of renal involvement. The risk of profound renal disease necessitating nephrology referral rose significantly with age and the presence of cutaneous bullae and/or necrosis.

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