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      Púrpura de Henoch Schönlein en niños: casuistica del Hospital de Gandia, Valencia. España Translated title: Henoch Schonlein purpura in children: Casuistic from the Hospital of Gandia. Valencia. Spain

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          Abstract

          La Purpura de Henoch Schonlein (PHS) es la vasculitis mas frecuente en pediatría. Su análisis epidemiológico, clínico y evolución, son importantes en el manejo de los pacientes. Objetivo general: Revisar unas serie de pacientes con PHS de un hospital de referencia comarcal. Método: Se recogió información de las historias clínicas y se analizaron los datos de acuerdo a parámetros definidos. Resultados: 17 pacientes menores de 15 años fueron evaluados; esta cifra corresponde a 29 casos/año/100.000 habitantes <15años edad promedio 6.12±4.9 años; predominio del sexo masculino; la mayoría de los casos se presentó en otoño e invierno. Se detectó antecedente infeccioso previo o concomitante en 47% de los casos, predominantemente infecciones del tracto respiratorio superior y, la forma de presentación mas frecuente fue la tríada: purpura cutánea palpable, manifestaciones gastrointestinales y articulares. Se encontró que 53% de los pacientes presentaron manifestación nefrológica inicial, predominando hematuria y proteinuria. Todos los casos mantuvieron función de filtración renal normal. Estreptococo beta hemolítico fue aislado en un tercio de los casos. Todos los pacientes han evolucionado satisfactoriamente después de 11±7 meses de seguimiento ambulatorio. Conclusiones: La casuística de PHS en este hospital muestra que la incidencia es mayor al promedio reportado en la mayoría de las casuísticas internacionales y es mayor en otoño, distinto a lo habitualmente reportado. Esto sugiere la probable existencia de factores ambientales, microbiológicos, o de otra índole, no precisados, lo cual ameritaría estudios pertinentes en materia de salud publica.

          Translated abstract

          Background: Henoch Schonlein Purpura (HSP) is the commonest vasculitis in children. To perform epidemiological analysis and to evaluate clinic features and results of follow up are important for the adequate management of patients. Objectives: To review epidemiologic characteristics of HSP in a series of patients attended in a referral hospital in Spain and to analyze clinical, laboratory results and evolution of patients. Methods: Data from the clinical records was collected and analyzed according to defined parameters. Results: 17 patients under 15 years of age were evaluated; it corresponds to 29 cases/year/100.000 IH <15 years. Mean age 6.12±4.9 years. The majority of cases presented in autumn and winter. Infectious antecedent or simultaneous infection with the onset was detected in 47% of cases mainly in upper respiratory tract. Clinical presentation was the classical triad of palpable cutaneous purpura, gastrointestinal and joints manifestations. Initial nephrologic manifestations were found in 53% of cases, predominantly hematuria and proteinuria, with normal glomerular filtration ratio. Beta hemolytic streptococcus was isolated in one third of cases. After ambulatory follow up of 11±7 months all patients have had uneventful recovery. Conclusions: this casuistic of PHS shows that the incidence in this geographic area is higher compared with the majority of international and national series and it is more frequent in autumn, which is different to the reported in other series. This suggests the probable presence of environmental, microbiologic or another features, no clearly known, which requires analysis from the public health point of view.

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          Henoch-Schönlein Purpura in Northern Spain

          Abstract The severity of clinical features and the outcomes in previous series of patients reported with Henoch-Schönlein purpura (HSP) vary greatly, probably due to selection bias. To establish the actual clinical spectrum of HSP in all age groups using an unselected and wide series of patients diagnosed at a single center, we performed a retrospective review of 417 patients classified as having HSP according to the criteria proposed by Michel et al. Of 417 patients, 240 were male and 177 female, with a median age at the time of disease diagnosis of 7.5 years (interquartile range [IQR], 5.3–20.1 yr). Three-quarters of the patients were children or young people aged 20 years or younger (n = 315), and one-quarter were adults (n = 102). The most frequent precipitating events were a previous infection (38%), usually an upper respiratory tract infection, and/or drug intake (18.5%) shortly before the onset of the vasculitis. At disease onset the most common manifestations were skin lesions (55.9%), nephropathy (24%), gastrointestinal involvement (13.7%), joint symptoms (9.1%), and fever (6.2%). Cutaneous involvement occurring in all patients, mainly purpuric skin lesion, was the most common manifestation when the vasculitis was fully established, followed by gastrointestinal (64.5%), joint (63.1%), and renal involvement (41.2%). The main laboratory findings were leukocytosis (36.7%), anemia (8.9%), and increased serum IgA levels (31.7%). The most frequent therapies used were corticosteroids (35%), nonsteroidal antiinflammatory drugs (14%), and cytotoxic agents (5%). After a median follow-up of 12 months (IQR, 2–38 mo), complete recovery was observed in most cases (n = 346; 83.2%), while persistent, usually mild, nephropathy was observed in only 32 (7.7%) cases. Relapses were observed in almost a third of patients (n = 133; 31.9%). In conclusion, although HSP is a typical vasculitis affecting children and young people, it is not uncommon in adults. The prognosis is favorable in most cases, depending largely on renal involvement.
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            Clinical practice: Diagnosis and management of Henoch-Schönlein purpura.

            Henoch-Schönlein purpura (HSP) is the most common vasculitis of childhood. In this review, the main clinical features and complications are described. Although most features are self-limiting, renal disease is the most likely to result in long-term morbidity. Treatment of HSP nephritis is controversial, and the evidence for both prevention and treatment of established disease is reviewed. Follow-up for children presenting with HSP should be for at least 6 months and should include regular urine testing for proteinuria and haematuria and a blood pressure measurement. Women with a history of HSP during childhood are at increased risk of complications (such as proteinuria and hypertension) during pregnancy and should be monitored closely. This paper describes current practice with regard to investigation and management and proposes a practical care pathway of the management of a child with HSP.
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              Henoch Schonlein purpura in children: an epidemiological study among Dutch paediatricians on incidence and diagnostic criteria.

              The aim of the present study on the occurrence of Henoch-Schönlein Purpura (HSP) in Dutch children is to give some insight into the epidemiology of HSP in the Netherlands, to record the diagnostic criteria used by Dutch paediatricians and to evaluate the accuracy of the latter using the presence of IgA in the skin when biopsies are available. Each month in 2004, all Dutch paediatricians received an electronic card asking them to mention new diagnosed HSP. Paediatricians reporting one or more new patients with HSP were sent a list of questions concerning various parameters. 232 patients from 0 to 18 years of age (6.1/10(5)) were reported as having contracted HSP in 2004. 29% presented renal symptoms. In accordance with the classification criteria of the American College of Rheumatology, 80% of paediatricians consider that isolated purpura (without haematological abnormalities) is sufficient to allow the diagnosis of HSP in children. From the 17 skin biopsies performed, only 9 (53%) presented IgA deposits. The follow-up duration, considered as necessary, was longer in case of renal symptoms at presentation. However, 45% of patients without renal symptoms would be followed for more than 1 year. Considering the recent (2006) EULAR/PReS endorsed consensus criteria for the classification of childhood vasculitides, HSP should have been diagnosed in only 160 of the 179 patients of our study. The use of isolated non-thrombocytopenic purpura as the only criterion to diagnose HSP in children might therefore lead to over diagnosis and unnecessary follow-up.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                avpp
                Archivos Venezolanos de Puericultura y Pediatría
                Arch Venez Puer Ped
                Sociedad Venezolana de Puericultura y Pediatría (Caracas, Distrito Capital, Venezuela )
                0004-0649
                June 2017
                : 80
                : 2
                : 47-51
                Affiliations
                [01] Valencia orgnameHospital Francisco de Borja España
                Article
                S0004-06492017000200003
                d17f0bc8-999b-47ba-bb96-2e7ca16e6319

                http://creativecommons.org/licenses/by/4.0/

                History
                : 26 June 2017
                : 27 May 2017
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 35, Pages: 5
                Product

                SciELO Venezuela


                hematuria,vasculitis,nefritis,Purpura de Henoch Schonlein,nephritis,Henoch-Schonlein purpura

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