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Gastrointestinal
and renal involvement in vasculitis:
Management strategies in Henoch-Schönlein purpura
I.S. Szer
Abstract
The joint pain, inflammation,
and painful cutaneous edema of Henoch-Schönlein purpura (HSP) are effectively treated
with analgesics, nonsteroidal anti-inflammatory agents, and corticosteroids, but the
optimal management of HSP-associated gastrointestinal and renal involvement has not yet
been determined. The results of mostly anecdotal and uncontrolled studies favor a short
course of oral corticosteroids for severe abdominal pain and aggressive immunosuppressive
therapy for patients with progressive HSP nephritis.
Key Points
- HSP in adults tends to be chronic, and the
prognosis depends on the extent and nature of renal involvement.
- HSP tends to be more common in fall, winter, and
spring and is preceded in half of patients by an upper respiratory tract infection.
- Corticosteroids may be associated with a reduction
and more rapid resolution of abdominal pain, melena, and intestinal hemorrhage.
- Renal disease may not be present during the
initial episode of HSP and may develop up to 3 months into the course of illness.
- Transient hematuria is the most common renal
manifestation of HSP, described in 90% of patients. Recurrent hematuria occurs in 5% of
patients.
Author
Ilona S. Szer, MD
Clinical Professor of Pediatrics, University of California-San Diego School of Medicine,
Director, Pediatric Rheumatology, Children’s Hospital, San Diego
Address: Ilona S. Szer, MD, Director, Pediatric Rheumatology Children’s Hospital San
Diego, 3030 Children’s Way, San Diego, CA 92123-4282.
John D. Clough, M.D., editor-in-chief
Linda K. Hengstler, editor and publisher
Phillip E. Canuto, executive editor
Ray Borazanian, managing editor |
