Henoch Schönlein Purpuralı 137 Olgunun 10 Yıllık Retrospektif Değerlendirilmesi

Year 2011, Volume: 9 Issue: 3, 63 - 67, 01.12.2011

Osman Dönmez Nihal Sargın Yıldırım Oğuzhan Durmaz

Abstract

Giriş: Bu çalışmamızda Uludağ Üniversitesi Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Çocuk Nefroloji Bilim Dalında 1999-2009 yılları arasında en az bir yıllık izlemi olan HSP tanısı alan çocuklar laboratuar, klinik ve izlem sonuçları ile değerlendirildi. Gereç ve Yöntem: Uludağ Üniversitesi Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Pediatrik Nefroloji Bilim Dalında 1999-2009 yılları arasında en az bir yıllık izlemi olan HSP’li çocukların epidemiyolojik, klinik, laboratuar bulguları ve tedavi bilgileri dosya kayıtları incelenerek elde edildi. Bulgular: Çalışmaya alınan 137 HSP’li hastanın 48’i kız %35 , 89’u erkek %65 idi. Tüm olgularda nontrombositopenik purpurik döküntüler gözlendi. Seksen bir %59,1 hastada Eklem tutulumu, 4 %2,9 hastada pulmoner tutulum, 99 %72,3 hastada gastrointestinal GİS tutulum mevcuttu. Otuz hastaya böbrek biyopsisi yapıldı ve hastaların 16’sında %11,7 evre 1, 2’sinde %1,5 evre 2A, 3’ünde %2,2 evre 2B, 3’ünde %2,2 evre 3A, 5’inde %3,6 evre 3B ve 1’inde %0,7 evre 4 tutulum saptandı. Meadow sınıflamasına göre hastalar klinik açıdan değerlendirildiğinde en sık mikroskobik hematüri 55 %40,1 görüldü. Onbeş %10,9 hastada akut nefritik sendrom saptanırken 7 %5,19 hastada da nefrotik sendrom, 4 %2,9 hastada Ailevi Akdeniz Ateşi, 1 %0,7 hastada Poliarteritis Nodosa saptandı. Laboratuvar bulgularında 60 %43,8 hastada lökosit >10.000 saptandı. Hastaların 72’si %52,6 herhangi bir tedavi uygulanmadan izlendi, diğer hastalarda hastalığın ağırlığına göre steroid, NSAİİ veya immünsüpresif tedavi uygulandı. Takipteki hastaların 16’sında %11,7 nüks saptandı. Sonuç: Henoch Schönlein purpurası spontan iyileşebilen, ancak kimi zaman ölümle sonuçlanabilecek kadar ağır komplikasyonlara yol açabilen ve kimi zaman da atipik seyirle gidebilen bir hastalıktır. Akut dönemde hastaların komplikasyonlar açısından çok yakın izlemi ve olabilecek nüksler ve özellikle böbrek tutulumu açısından uzun süreli izlemleri son derece gereklidir. Gün cel Pe di at ri 2011; 9: 63-7

Keywords

Henoch-Schönlein purpurası, vaskülit, çocuklar

A Ten-Year Retrospective Evaluation of 137 Patients with Henoch Schonlein’s Purpura

Abstract

Introduction: In this study, we have evaluated laboratory, clinical characteristics, and results of Henoch Schonlein’s purpura HSP patients diagnosed in Uludag University Hospital Pediatric Nephrology outpatient clinic between 1999 and 2009. Material and Methods: The laboratory, clinical characteristics, and results of the patients were derived from hospital records. Results: Of 137 HSP patients, 48 35% were girls, 89 65% were boys. Nonthrombocytopenic purpura was present in all patients. Joint involvement was seen in 81 59.1% patients. Pulmonary involvement was seen in 4 2.9% patients. Gastrointestinal system involvement was seen in 99 72.3% patients. Thirty patients underwent a kidney biopsy. In 16 11.7% patients grade I, in 2 1.5% patients grade 2A, in 3 2.2% patients grade 2B, in 3 2.2% patients grade 3A, in 5 3.6% patients grade 3B, and in 1 0.7% patient grade 4 renal involvement was present. When we evaluated the patients according to Meadow’s classification, microscopic hematuria was the most commonly seen finding in 55 %40.1 patients. Acute nephritic syndrome was present in 15 10.9% patients, nephrotic syndrome in 7 5.19% patients, familial Mediterranean fever in four 4 2.9% patients and poliarteritis nodosa in one 0.7% patient. On laboratory findings, leukocyte >10000/ml was seen in 60 43.8% patients. Seventy two 52.6% patients were followed without treatment. Other patients were treated with steroids, NSAID and immunosuppressive therapy according to the severity of diseases. In 16 11.7% patients recurrence was seen. Conclusion: HSP is a disease that can spontaneously resolve, but sometimes can be present with complications leading to death. Some patients show atypical manifestations. While acutely diagnosed patients should be inspected for complications, the patients should be closely monitored for recurrences and renal involvement after acute period. Jo ur nal of Cur rent Pe di at - rics 2011; 9: 63-7

Keywords

Henoch-Schönlein purpura, vasculitis, children

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