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365 Profile of henoch schonlein purpura (hsp) nephritis: 23 years experience at a tertiary care centre in north india
  1. A Gupta1,
  2. A Kumar1,
  3. A Gupta1,
  4. R Nada2,
  5. RW Minz3,
  6. D Suri1,
  7. A Rawat1 and
  8. S Singh1
  1. 1PGIMER, Allergy Immunology Unit- Advanced Paediatrics Centre, Chandigarh, India
  2. 2PGIMER, Department of Histopathology, Chandigarh, India
  3. 3PGIMER, Department of Immunopathology, Chandigarh, India

Abstract

Background and aims Henoch Schonlein Purpura (HSP) is one of the most common vasculitides of childhood. Glomerulonephritis is seen in approximately 30%–50% of the patients and is the principal cause of morbidity and mortality in HSP patients.

Methods 314 children were diagnosed with HSP from 1993–2015 based on EULAR/PRINTO/PRES criteria. A retrospective case review of all patients with HSP Nephritis (HSPN) was done. HSPN was defined based on urine erythrocyte >5/HPF and proteinuria. Patients were divided into four clinical types (Table 1). The severity of renal pathological findings was determined based on the classification of International Study of Kidney Disease (ISKDC), from grades I – VI.

Abstract 365 Table 1

Clinical subtypes of HSPN.

Results Renal involvement was seen in 64 patients after a mean duration of 32.3 days from the onset of symptoms of HSP. Details of patients with HSPN is summarised in table 2, 3 and figure 1. Three fourth of the patients had histological grade II or IIIa (Figure 2). 75% of patients with grade ≥ IV had gross hematuria at presentation. Treatment details are shown in figure 3. Patients were followed up for a mean period of 42.9 months during which 13 were lost to follow up and 1 expired. Nephritis resolved in 48 patients (75%). 13 patients developed renal relapse manifesting as albuminuria with microscopic hematuria in 77% patients followed by isolated albuminuria (23%).

Abstract 365 Table 2

Details of patients with HSPN

Abstract 365 Table 3

Percentage of various clinical subtypes of HSPN.

Abstract 365 Figure 1

Timing of renal involvement from onset of HSP

Abstract 365 Figure 2

Percentage of various histological grades on renal biopsy.

Abstract 365 Figure 3

Treatment in patients with HSPN.

Conclusions Renal involvement was noted in 20.4% of children with HSP. Massive proteinuria was the most common clinical feature. Grade II and IIIa were the most common renal pathological grades.

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