Acute reversible renal failure with macroscopic hematuria in Henoch-Schönlein purpura

A Japanese girl aged 5 years 4 months developed macroscopic hematuria and acute renal failure (ARF) 8 days before the appearance of purpura rash. A renal biopsy undertaken during the acute phase of illness revealed many red blood cells in the tubular lumina with no apparent glomerular lesions. ARF showed improvement without dialysis therapy. A second renal biopsy was performed 2.5 months later because of the prolonged proteinuria and hematuria. Sclerotic change and crescent formation were demonstrated in 30% and 20% of glomeruli, respectively. Red blood cell casts in the tubular lumina were completely resolved. It is likely that the tubular change was involved in the development of ARF at the onset of illness. Although ARF during or after episodes of macroscopic hematuria has been observed in IgA nephropathy, it may occur as an uncommon complication in Henoch-Schönlein nephritis, which is a common glomerulonephritis in children.