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[Renal involvement in anaphylactoid purpura with particular reference to serum immunoglobulin]
Insights
Anaphylactoid purpura in children often involves the kidneys, with older children experiencing higher rates. While immunoglobulin levels may be elevated, hypertension serves as a key indicator of renal involvement.
Area of Science:
- Pediatrics
- Nephrology
- Immunology
Background:
- Anaphylactoid purpura (also known as Henoch-Schönlein purpura) is a common vasculitis in children.
- Renal involvement is a significant complication that can affect prognosis.
Purpose of the Study:
- To investigate the incidence, clinical features, and outcomes of renal involvement in children with anaphylactoid purpura.
- To explore the correlation between age, immunoglobulin levels, and renal disease.
Main Methods:
- A retrospective study of 88 children diagnosed with anaphylactoid purpura.
- Analysis of clinical data including renal manifestations (hematuria, proteinuria), age, immunoglobulin A (IgA) and E (IgE) levels, antinuclear antibody, antistreptolysin O titer, and blood pressure.
Main Results:
- Fifty-one children (58%) recovered rapidly without renal involvement.
- Renal involvement, characterized by hematuria and/or proteinuria, occurred in a significant proportion of patients.
- Older children (over nine years) had a higher incidence of renal involvement (p < 0.005).
- Hypertension was noted in 15 children, all with renal involvement, suggesting it is a good indicator.
- Elevated serum IgA and IgE levels were observed in 44.7% and 36.4% of patients, respectively, but did not influence renal involvement or prognosis.
- Serum IgA and IgE levels decreased significantly during the convalescent stage.
Conclusions:
- Renal involvement in anaphylactoid purpura is common and more frequent in older children.
- Hypertension is a valuable clinical indicator of renal disease in these patients.
- Further research is warranted to elucidate the role of immunoglobulin E in the pathogenesis and prognosis.
Abstract:
Eighty-eight children of anaphylactoid purpura were studied in the Department of Pediatrics from September 1979 to September 1987. Fifty-one children without renal involvement recovered rapidly. Seven children with hematuria or proteinuria and fourteen children with both manifestations recovered fully within six weeks also. Two patients with hematuria and proteinuria recovered two months and four months, respectively, after diagnosis. Ten children had persistent hematuria and proteinuria lasting for more than six months; of these five children recovered and four improved; one child died of intracranial hemorrhage and severe infection. Nephrotic syndrome was noted in five children. Most of them (greater than 80%) had persistent proteinuria more than six months. Incidence of renal involvement was correlated with age. Older children especially those of more than nine years old had a higher incidence rate (p less than 0.005). Serum immunoglobulin A (IgA) and immunoglobulin E (IgE) levels were significantly elevated in 44.7% and 36.4% of patients respectively, but neither influenced the incidence of renal involvement or prognosis of renal disease. Elevated serum IgA and IgE levels in acute stage were significantly reduced in 100% and 83% of children when they were followed in convalescent stage (p less than 0.05). The role of IgE deserves further study. Antinuclear antibody was positive in two children without nephritis. Hypertension was noted in fifteen children, all with renal involvement. Hypertension appears to be a good indicator for renal involvement. Antistreptolysin O titer was elevated in 31.7% of children, but had no significant correlation with incidence of renal involvement.