Kidney Week

Abstract: TH-PO185

Henoch-Schönlein Purpura Nephritis: Not Only a Childhood Disease

Session Information

• Fellows/Residents Case Reports: Glomerulonephritis
  November 02, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Nephrology Education

• 1302 Fellows and Residents Case Reports

Authors

• Andujar, Krystahl Z., University of Puerto Rico, Medical Sciences Campus, San Juan , Puerto Rico, United States

Krystahl Z. Andujar,

• Ocasio Melendez, Ileana E., University of Puerto Rico, Medical Sciences Campus, San Juan , Puerto Rico, United States

Ileana E. Ocasio Melendez,

• Canales-Ramos, Nicolle M, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico, United States

Nicolle M Canales-Ramos,

• Medina aviles, Sharlene, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico, United States

Sharlene Medina aviles,

• Cintron-Rosa, Fatima B., University of Puerto Rico, Medical Sciences Campus, San Juan , Puerto Rico, United States

Fatima B. Cintron-Rosa,

• Collazo Gutierrez, Naomi, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico, United States

Naomi Collazo Gutierrez,

• Alvarez, Luis F, VA Caribbean Healthcare System, San Juan, Puerto Rico, United States

Luis F Alvarez,

• Ruiz, Phillip, University Of Miami, Miami, Florida, United States

Phillip Ruiz,

Background

Henoch-Schönlein Purpura Nephritis (HSPN) is often regarded as a childhood disease. As adults are at more risk for developing chronic kidney disease (CKD) if treatment is delayed, it is vital for clinicians to be aware of this rare disease.

Methods

A 51-year-old Puerto Rican man without medical history presented with abdominal pain associated with bloody stools, a rash on lower extremities and arthralgias. Palpable purpura was visible on legs, back and buttocks. Vital signs were normal. Laboratories were remarkable for a creatinine of 2 mg/dl. Urine protein:creatinine ratio revealed proteinuria of 1,988 mg/g. Urine microscopy showed dysmorphic red blood cells. Abdomino-pelvic computer tomography scan was diagnostic of colitis. Skin lesions biopsied demonstrated leukocytoclastic vasculitis. A renal biopsy was performed revealing increased mesangial cellularity on light microscopy and mesangial staining with IgA on immunofluorescence. In the presence of palpable purpura, arthralgias, colitis, proteinuria and renal biopsy evidence of IgA deposition, he was diagnosed with HSPN. After a three-day course of intravenous methylprednisolone, he was started on oral prednisone and azathioprine. Two weeks later, creatinine returned to baseline of 1 mg/dL, proteinuria improved and skin lesions and abdominal complaints resolved. He was started on losartan and a decision for immunosuppression weaning was reached.

Conclusion

HSPN is most prevalent in the first decade of life, making our adult case unusual. Renal involvement in adults with HSPN is worse than in children and up to forty percent of patients can progress to CKD. A challenge the clinician must face is balancing the cost of immunosuppressive treatment versus the actual risk of developing CKD. Also, the difficult decision of choosing which immunosuppressive agent is most beneficial for the patient. A clinical trial by Bergstein et al suggest that corticosteroid and azathioprine therapy is beneficial in treating HSPN. In our case, treatment with this immunosuppressive therapy proved to be effective in eliminating abdominal complaints, decreasing proteinuria and improving renal function. Nonetheless, more evidence-based recommendations are needed to pinpoint which immunosuppressive agent is the choice of therapy for HSPN.