الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Henoch-Schönlein purpura (HSP) is the most common vasculitis affecting children and the most common cause of non-thrombocytopenic purpura in children. There are no published studies in the international literature on HSP in Egyptian children.
The aim of the present work was to analyze the clinical and laboratory data of children with HSP admitted to the Alexandria University Children’s Hospital from July 2010 to June 2012. The data were collected from the files of 39 patients, tabulated and statistically analyzed. After a period of 11-30 months following the onset of the disease, data about recurrences were collected by telephone interview with the parents. Cases that had renal involvement were called for follow-up urinalysis and kidney function tests.
The following results were obtained
1. The mean age of the patients was 5.9 ± 2.8 years, and both sexes were equally affected.
2. More than half (54%) of the cases occurred in autumn.
3. More than half (54%) of the cases were from Alexandria, the remainders came from neighbouring governorates.
4. A potential trigger event (infection) occurred in 38.5% of the cases.
5. Purpura was present in all the cases, gastrointestinal (GI) involvement in 79.5%, joint involvement in 64% and renal involvement in 20.5% of the cases.
6. Purpura was the first symptom in 69% of the cases, while joint affection and abdominal pain were the first symptoms in 18% and 13% of the cases respectively.
7. Intussusception occurred in 4 (11%) of the cases, resolved spontaneously in 3 cases and required surgical intervention in one patient.
8. Renal involvement was in the form of mild nephropathy (microscopic or macroscopic hematuria) in 6 cases (15.5%) and severe nephropathy (acute nephritis) in 2 cases (5%), one of them had acute renal insufficiency.
9. There was no significant relation between renal involvement and either age, sex or GI involvement.
10. Treatment given included NSAIDs in 38.5% of the cases, corticosteroids in 41% of the cases and antihypertensive drugs in 18% of the cases.
11. The mean hospital stay was 5.6 ± 3.6 days.
12. The manifestations of GI, joint and renal affection disappeared before discharge in all but one case, in whom microscopic hematuria and proteinuria disappeared after 2 months.
13. Relapses (1-3 relapses) occurred in 5 (20%) of the patients, were milder and shorter than the first attack.
14. There was no significant relation between relapses and age, sex, articular, abdominal or renal involvement, leukocytosis, anemia or elevated ESR values in the initial attack. Also, there was no significant influence of steroid treatment on occurrence of relapses.
15. None of the cases had life-threatening complications (except one case with intussusception) or developed chronic kidney disease.
from these results, it could be concluded that:
1. The present study comprised a relatively small cohort of HSP that can by no means depict the features of the disease in Egyptian children.
2. Gastrointestinal involvement was very common, while renal involvement was uncommon in the present series.
3. HSP should be considered in the diagnosis of any child with severe abdominal or joint pain, or intussusception above 2 years of age; even in the absence of the characteristic purpura.
4. Relapses were uncommon and were milder and shorter than the initial episode.
5. The overall prognosis of HSP in the present series was excellent, with begnin course and full recovery without chronic kidney disease or life-threatening complications in the great majority of the cases.
Consequently, it is recommended that:
1. The present study should be extended over the coming years for better delineation of the clinical and laboratory features, outcome and long-term prognosis of HSP in Egyptian children.
2. More emphasis should be laid on the long-term follow-up of the cases for evidence of chronic kidney disease in future studies.
3. A national multicenter study has to be initiated to define the features, best therapeutic strategies and outcome of severe HSP nephritis in Egyptian children, owing to the relative paucity of these cases in individual centers.