Forthcoming Issue Vol. 19 no. 2 A retrospective descriptive review of children diagnosed with Henoch Schönlein purpura at Red Cross War Memorial Children’s Hospital over a 5-year period (2015-2019)
Article Sidebar
Main Article Content
Abstract
Background: IgA vasculitis, formerly known as Henoch-Schönlein Purpura, is the most common primary vasculitis in childhood. The prevalence, variation in clinical features, and outcomes of IgA vasculitis in low-to-middle income countries are poorly understood, due to a lack of published research. This study aimed to provide a comprehensive description of IgA vasculitis cases encountered at a South African children's hospital.
Methods: A retrospective folder review of all children with a discharge diagnosis of IgA vasculitis at (RCWMCH) a tertiary children’s hospital between January 2015 and December 2019 was performed. Patient demographics, clinical characteristics, laboratory findings, management and short-term outcomes were summarised; conventional descriptive and inferential statistical methods were used to analyse the dataset.
Results: Forty-nine children were eligible for inclusion in the analysis, mean age was 6 years and 5 months, male-to-female ratio was 1:1. Rash was the presenting symptom in 48 (97%) children; arthralgia 41 (84%), abdominal pain 18 (37%); oedema manifested as scrotal oedema in 1 (2%) and angioedema in three (6%) children. Kidney involvement was evident in twenty-five (51%) children with proteinuria and or haematuria, while isolated microscopic haematuria occurred in six (12%). Complications were infrequent, five (10%) patients had IgA nephritis on biopsy and one (2%) had a gastrointestinal bleed. The mean length of hospital stay was 1.6 (SD 2) days. At one year of follow-up, two (4%) children had persistent proteinuria and only one patient (2%) still had haematuria.
Conclusion: The clinical course of IgA vasculitis in this cohort of South African children was mostly self-limiting, consistent with international literature. However, patients with persistent haematuria or proteinuria require longer-term follow-up. Collaborative studies within South Africa and sub-Saharan Africa may provide a more accurate picture of the epidemiology of childhood HSP and its complication rates.
Word count: 292
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The SAJCH is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
How to Cite
References
Breda, L., I. Carbone, I. Casciato, et al., Epidemiological and clinical aspects of immunoglobulin A vasculitis in childhood: a retrospective cohort study. Ital J Pediatr, 2021. 47(1): p. 237 DOI: 10.1186/s13052-021-01182-6.
Ozen, S., A. Pistorio, S.M. Iusan, et al., EULAR/PRINTO/PRES criteria for Henoch-Schönlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II: Final classification criteria. Ann Rheum Dis, 2010. 69(5): p. 798-806 DOI: 10.1136/ard.2009.116657.
Ozen, S., S.D. Marks, P. Brogan, et al., European consensus-based recommendations for diagnosis and treatment of immunoglobulin A vasculitis-the SHARE initiative. Rheumatology (Oxford), 2019. 58(9): p. 1607-1616 DOI: 10.1093/rheumatology/kez041.
Grover, I.G.M.C. Dept. of Pediatrics, Shimla, Himachal Pradesh, India. [email protected], S. N, et al., A five year review of clinical profile in HSP. JNMA, 2007. 46.
López-Mejías, R., F.D. Carmona, S. Castañeda, et al., A genome-wide association study suggests the HLA Class II region as the major susceptibility locus for IgA vasculitis. Scientific Reports, 2017. 7(1): p. 5088 DOI: 10.1038/s41598-017-03915-2.
Heineke, M.H., A.V. Ballering, A. Jamin, et al., New insights in the pathogenesis of immunoglobulin A vasculitis (Henoch-Schonlein purpura). Autoimmun Rev, 2017. 16(12): p. 1246-1253 DOI: 10.1016/j.autrev.2017.10.009.
Tracy, A., A. Subramanian, N.J. Adderley, et al., Cardiovascular, thromboembolic and renal outcomes in IgA vasculitis (Henoch-Schonlein purpura): a retrospective cohort study using routinely collected primary care data. Ann Rheum Dis, 2019. 78(2): p. 261-269 DOI: 10.1136/annrheumdis-2018-214142.
Dyga, K. and M. Szczepańska, IgA vasculitis with nephritis in children. Adv Clin Exp Med, 2020. 29(4): p. 513-519 DOI: 10.17219/acem/112566.
Hetland, L.E., K.S. Susrud, K.H. Lindahl, et al., Henoch-Schonlein Purpura: A Literature Review. Acta Derm Venereol, 2017. 97(10): p. 1160-1166 DOI: 10.2340/00015555-2733.
Sinclair, P., . Current Allergy & Clinical Immunology, 2010. 23(3) DOI: DOI: doi:10.10520/EJC21678.
Mitchell, J.G., . 2010.
Kellum, J.A. and N. Lameire, Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care, 2013. 17(1): p. 204 DOI: 10.1186/cc11454.
Watts, R.A., G. Hatemi, J.C. Burns, et al., Global epidemiology of vasculitis. Nature Reviews Rheumatology, 2022. 18(1): p. 22-34 DOI: 10.1038/s41584-021-00718-8.
Trapani, S., A. Micheli, F. Grisolia, et al., Henoch Schonlein Purpura in Childhood: Epidemiological and Clinical Analysis of 150 Cases Over a 5-year Period and Review of Literature. Seminars in Arthritis and Rheumatism, 2005. 35(3): p. 143-153 DOI: doi.org/10.1016/j.semarthrit.2005.08.007.
Scott, C., S. Sawhney, and L.B. Lewandowski, Pediatric Rheumatic Disease in Lower to Middle-Income Countries: Impact of Global Disparities, Ancestral Diversity, and the Path Forward. Rheum Dis Clin North Am, 2022. 48(1): p. 199-215 DOI: 10.1016/j.rdc.2021.09.001.
Naija, O., J. Bouzaraa, R. Goucha-Louzir, et al., [Predictive factors of severe Henoch-Schonlein nephritis in children: report of 34 cases]. Tunis Med, 2012. 90(12): p. 878-81.
Coppo, R., A. Amore, and B. Gianoglio, Clinical features of Henoch-Schönlein purpura. Italian Group of Renal Immunopathology. Ann Med Interne (Paris), 1999. 150(2): p. 143-50.
Reamy, B.V., J.T. Servey, and P.M. Williams, Henoch-Schönlein Purpura (IgA Vasculitis): Rapid Evidence Review. Am Fam Physician, 2020. 102(4): p. 229-233.
Chan, H., Y.-L. Tang, X.-H. Lv, et al., Risk Factors Associated with Renal Involvement in Childhood Henoch-Schönlein Purpura: A Meta-Analysis. PLOS ONE, 2016. 11(11): p. e0167346 DOI: 10.1371/journal.pone.0167346.
Pillebout, E., A. Jamin, H. Ayari, et al., Biomarkers of IgA vasculitis nephritis in children. PLOS ONE, 2017. 12(11): p. e0188718 DOI: 10.1371/journal.pone.0188718.
Narchi, H., Risk of long term renal impairment and duration of follow up recommended for Henoch-Schonlein purpura with normal or minimal urinary findings: a systematic review. Archives of disease in childhood, 2005. 90(9): p. 916-920 DOI: 10.1136/adc.2005.074641.
Dudley, J., G. Smith, A. Llewelyn-Edwards, et al., Randomised, double-blind, placebo-controlled trial to determine whether steroids reduce the incidence and severity of nephropathy in Henoch-Schonlein Purpura (HSP). Arch Dis Child, 2013. 98(10): p. 756-63 DOI: 10.1136/archdischild-2013-303642.
Parajuli, S., U. Paudel, D.P. Koirala, et al., Hemorrhagic bullae in henoch-schonlein purpura: A case report. Journal of College of Medical Sciences-Nepal, 2012. 6(4): p. 46-48 DOI: 10.3126/jcmsn.v6i4.6725.
Lee, K.H., J.H. Park, D.H. Kim, et al., Dapsone as a potential treatment option for Henoch-Schönlein Purpura (HSP). Medical Hypotheses, 2017. 108: p. 42-45 DOI: https://doi.org/10.1016/j.mehy.2017.07.018.
Daniels, A., R. Muloiwa, L. Myer, et al., Examining the reliability of ICD-10 discharge coding in Red Cross War Memorial Children's Hospital administrative database. S Afr Med J, 2021. 111(2): p. 137-142 DOI: 10.7196/SAMJ.2021.v111i2.14686.