Transformations of organ lesions in hemorrhagic vasculitis

Abstract

Background. Hemorrhagic vasculitis or Henoch-Schönlein purpura (HSP) is the most common variant of systemic vasculitis in childhood, and peculiarities of the further transformation of the pathological process in adult patients remain unexplored. Objective. To explore the transformation of juvenile HSP, comparing the nature of skin lesions, joints and kidneys of patients in childhood and adulthood. Material and methods. The study included 92 patients (61 men and 31 women on the average age of 27 years, and at the onset of the disease in 11 years). I degree of the activity of the pathological process is determined in 40% of cases, II - in 35%, III – in 25%. Seropositivity by hyperimmunoglobulinemia A occurred in 27% of cases, by the presence of rheumatoid factor – in 21%. At the time of the survey cutaneous syndrome was diagnosed in 55% of patients, the joint – in 45%, kidney – in 71%. There were performed renal biopsy in 15 cases. Results. The cutaneous, joint-cutaneous-abdominal and cutaneous -abdominallyrenal forms of the disease, lesions of the skin, gastrointestinal tract, wrist, ankle and knee joints become more rarely in the course of evolution of juvenile HSP, but exceptionally renal variant of the pathological process, the change of skeletal muscle, liver, spleen are revealed more often. Chronic kidney disease with the kidney failure progression is developed in 12% of patients (in 17% of cases of nephropathy). Sacroiliitis, spondylopathy, tendovaginitis, enthesopathies, epiphyseal osteoporosis, meniscitis of knee joints are arisen. II, III, VI and IV morphological classes of Henoch glomerulonephritis are formed in a ratio of 8:4:2:1 with tubulointerstitial component in all cases. And lymphohistiocytic infiltration of the vascular wall is the unfavorable sign for the prognosis of the disease. Conclusions: In cases of transfer of juvenile HSP in chronic adult form disease often obtain progressive course as regards, first of all, the pathology of the joints and kidneys

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