Prognostic implications of normal or minimal urinary findings on long-term renal impairment in adults with Henoch-Schönlein purpura - 24/02/20

Doi : 10.1016/j.jaad.2019.12.037

Emily Baumrin, MD ^a,^⁎ , Soraya Azzawi, MD ^b, Jessica St. John, MD, MPH, MBA ^c, Mai P. Hoang, MD ^d, Steven Chen, MD, MPH ^c, Camden P. Bay, PhD ^e, Daniela Kroshinsky, MD, MPH ^c
^a Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
^b Harvard Medical School, Boston, Massachusetts
^c Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
^d Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
^e Center for Clinical Investigation, Brigham and Women's Hospital, Boston, Massachusetts

^∗Correspondence to: Emily Baumrin, MD, Department of Dermatology, Brigham and Women's Hospital, 41 Avenue Louis Pasteur, EC 313, Boston, MA 02115.Department of DermatologyBrigham and Women's Hospital41 Avenue Louis Pasteur, EC 313BostonMA02115

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Monday 24 February 2020

Abstract

Background

Renal involvement in adult Henoch-Schönlein purpura is a major cause of morbidity and can lead to significant long-term renal impairment. The prognostic significance of normal or minimal urinary abnormalities at diagnosis is unknown.

Objective

To assess the risk of long-term renal impairment in patients with Henoch-Schönlein purpura who present with normal or minimal urinary abnormalities.

Methods

Retrospective cohort study of adult Henoch-Schönlein purpura patients presenting with normal urinalysis results, microscopic hematuria, or low-grade proteinuria. Patients were followed for development of long-term renal impairment, with adjusting for comorbidities.

Results

Forty-seven patients were included, with median follow-up 73.9 months (interquartile range 35 to 98 months). Thirty-nine patients (83.0%) had abnormal urinalysis results, of whom 15 (38.5%) progressed to long-term renal impairment. In contrast, 8 patients (17%) had normal urinalysis results, of whom only 1 (12.5%) developed long-term renal impairment (adjusted hazard ratio 10.58; 95% confidence interval 1.18-94.73). Renal events occurred at a median 36.1 months (interquartile range 17.1 to 61 months) from diagnosis, earlier in patients with comorbidities compared with those with none, and in a constant event rate over time.

Limitations

Small sample size.

Conclusions

Microscopic hematuria and low-grade proteinuria at Henoch-Schönlein purpura diagnosis is a poor prognostic sign for the development of long-term renal impairment. This population should be targeted for prolonged surveillance.

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Key words : hematuria, Henoch-Schönlein purpura, HSP, IgA, kidney, proteinuria

Plan

	Funding sources: None.
	Conflicts of interest: None disclosed.
	This clinical trial was approved by Partners Health IRB (approval 2017P001248).
	Reprints not available from the authors.