Obesity is associated with severe clinical course in children with Henoch-Schonlein purpura
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ORIGINAL ARTICLE
Obesity is associated with severe clinical course in children with Henoch-Schonlein purpura Hatice Adiguzel Dundar 1
&
Mehmet Pektanc 2 & Meral Torun Bayram 3 & Alper Soylu 1,3 & Salih Kavukcu 1,3
Received: 1 March 2020 / Revised: 17 May 2020 / Accepted: 11 June 2020 # IPNA 2020
Abstract Background We aimed to evaluate the role of obesity on the clinical course and response to treatment in patients with HenochSchonlein purpura (HSP). Methods Data charts of children with HSP followed in a tertiary hospital between 2000 and 2018 were reviewed retrospectively. Persistent purpura was defined as skin involvement persisting for ≥ 30 days. Mild nephropathy was defined as the presence of microscopical hematuria and/or non-nephrotic proteinuria, while severe nephropathy as nephrotic proteinuria, nephritic syndrome, and/or kidney insufficiency. Obese and non-obese patients were compared for demographic, clinical, and laboratory parameters. Results There were 199 patients (M/F, 104/95; median (IQR) presenting age 7.1 (5.0–9.2) years; follow-up period 17.5 (6–50) months). Obese patients (n = 35 (17.6%)) had significantly higher rate of persistent purpura (46% vs 21%), severe renal involvement (58% vs 31%), high-grade renal histopathological lesions (83% vs 39%), hypertension (29% vs 9%), and increased erythrocyte sedimentation rate (79% vs 56%). Obese patients also showed delayed improvement of cutaneous (25 vs 14 days), articular (12.5 vs 10.0 days), and kidney (280 vs 57 days) symptoms. Obese children used steroids for significantly longer period of time (236 vs 40 days). Furthermore, need for immunosuppressive medications were higher in obese patients (40% vs 9%). Conclusions Obese children with HSP had higher erythrocyte sedimentation rate, hypertension, and severe renal involvement; showed delayed improvement of skin, joint, and kidney findings; and need more immunosuppressive medications and a longer period of steroid treatment. These findings may be associated with the effect of adipose tissue on inflammation. Keywords Henoch-Schonlein purpura . Inflammation . Involvement . Obesity
* Hatice Adiguzel Dundar [email protected] Mehmet Pektanc [email protected] Meral Torun Bayram [email protected] Alper Soylu [email protected] Salih Kavukcu [email protected] 1
Faculty of Medicine, Department of Pediatric Rheumatology, Dokuz Eylul University, Izmir, Turkey
2
Faculty of Medicine, Department of Pediatrics, Dokuz Eylul University, Izmir, Turkey
3
Faculty of Medicine, Department of Pediatric Nephrology Units, Dokuz Eylul University, Izmir, Turkey
Introduction Henoch-Schonlein purpura (HSP) is the most frequent vasculitis in childhood with an incidence of 20/100.000 [1, 2]. Diagnosis of HSP is made by the demonstration of nonthrombocytopenic purpura and petechia prominent in the lower extremities along with the presence of at least one of the following 4 criteria: (1) abdominal pain, (2) arthritis/arthralgia, (3) kidney involvement, and (4) leukocytoclastic vasculi
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