Sano et al identified risk factors for significant renal involvement in patients with Henoch-Schonlein purpura. This can help identify patients who may be at risk for developing end-stage renal disease and who may benefit from more aggressive management. The authors are from Saitama Medical Scholl in Kawagoe, Japan.


A patient with Henoch-Schonlein purpura and hematuria without proteinuria almost always has a benign course, while increasing renal involvement with proteinuria is associated with increasing risk of end-stage renal disease.


Risk factors associated with significant renal involvement in multivariate analysis:

(1) severe abdominal symptoms

(2) age > 4 years

(3) persistent purpura


Risk factors associated with moderate to severe proteinuria (including the nephrotic syndrome):

(1) persistent purpura

(2) coagulation factor XIII activity < 80%

(3) treatment with factor XIII concentrate (which correlates with low Factor XIII levels)


Long-term prognosis in Henoch-Schonlein purpura is affected by the extent of renal involvement. A patient with risk factors for renal involvement or proteinuria should have renal function and urinalysis followed for at least 3 months after the onset of the disease.


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