Henoch-Schonlein purpura in a renal transplant recipient with prior IgA nephropathy following influenza vaccination

Background: IgA vasculitis is a small-vessel vasculitis caused by deposition of IgA antibodies in tissues. IgA nephropathy and IgAV have long been considered related conditions. Objective: To assess the prevalence and implications of new-onset Henoch-Schönlein purpura (HSP) after renal transplant in patients with underlying IgA nephropathy. Methods: The PubMed database was searched for keywords such as IgAV, IgA vasculitis, Henoch-Schönlein purpura, HSP, IgA nephropathy, and renal transplant. Results: Two cases of new-onset IgA vasculitis post–renal transplant after stopping the prednisone or receiving seasonal influenza vaccine have been reported. We report the case of new-onset IgA cutaneous vasculitis in a renal transplant patient with IgA nephropathy after reduction in his prednisone dosage. Conclusion: The new development of cutaneous IgA vasculitis is unusual in renal transplant patients with IgA nephropathy. Despite these patients’ being immunosuppressed, the presence of IgA vasculitis could signal the recurrence of IgA nephropathy.

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Renal Outcomes of Childhood IgA Nephropathy and Henoch Schönlein Purpura Nephritis

Siriraj Medical Journal ◽

10.33192/smj.2021.88 ◽

2021 ◽

Vol 73 (10) ◽

pp. 687-694

Author(s):

Thanaporn Chaiyapak ◽

Anirut Pattaragarn ◽

Suroj Supavekin ◽

Nuntawan Piyaphanee ◽

Kraisoon Lomjansook ◽

...

Keyword(s):

Iga Nephropathy ◽

Complete Recovery ◽

Clinicopathological Characteristics ◽

Henoch Schonlein Purpura ◽

Renal Outcomes ◽

Nephritic Syndrome ◽

Schonlein Purpura ◽

Henoch Schönlein Purpura ◽

Purpura Nephritis

Background: Henoch-Schönlein purpura nephritis (HSPN) is considered the systemic form of IgA nephropathy (IgAN). However, differing clinicopathological features and renal outcomes of children with IgAN and HSPN have been reported in some studies. Methods: This study retrospectively reviewed children with IgAN and HSPN younger than 18 years, between January 2004 and December 2015. The clinicopathological characteristics at diagnosis and the renal outcomes after at least 1 year of follow-up were compared between the two groups. Results: A total of 54 children, comprising 21 with IgAN and 33 with HSPN, were recruited. The children with HSPN were younger than the children with IgAN. Gross hematuria and nephritic syndrome at the initial presentation were more common in children with IgAN. Regarding the pathological findings, IgAN had greater chronicity than HSPN. After a median follow-up period from first presentation to renal outcomes measurement of 4.0 years (1.3-12.2) in children with IgAN and 4.2 years (1.1-11.4) in children with HSPN, the renal outcomes were better in the latter group. The incidence of chronic kidney disease (CKD) was 28.6% in children with IgAN and 6.1% in children with HSPN (p = 0.02). Complete recovery was observed more frequently in children with HSPN than in children with IgAN (57.1% in IgAN vs. 87.9% in HSPN, p = 0.01). Conclusions: Childhood IgAN has greater chronicity and worse renal outcomes than childhood HSPN, with a lower rate of complete recovery and a higher frequency of CKD. We recommend long-term follow-up for CKD in children with IgAN.

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