Jahed M. Hamdan

OBJECTIVE: To assess the epidemiological, clinical, and laboratory findings in children affected with Henoch-Schonlein purpura HSP, and to analyze the influence of age on the incidence of nephritis and arthritis. METHODS: This is a retrospective study of the case records of all patients admitted to Prince Rahmah Hospital, Irbid, Jordan with HSP from September 1997 to December 2006, and to King Abdullah University Hospital, Irbid, Jordan from August 2005 to December 2006. RESULTS: The clinical manifestations included purpura in 100% of the 68 patients, arthritis in 75%, and nephritis in 29%. The incidence of nephritis varied according to the age of patients. It occurred in 19% of children less than 5 years of age, and in 67% of children 10 years of age and above. Henoch-Schonlein purpura nephritis was mild in all age groups. The incidence of arthritis also varied according to the age of patients. Arthritis occurred in 56% of children less than 5 years of age, and in 89% of children 10 years of age and above. CONCLUSION: The incidence of nephritis and arthritis in children affected with HSP is age related. Older children have a higher incidence of nephritis and arthritis, while younger children have a lower incidence of nephritis and arthritis. Renal involvement was mild during the acute phase of the disease in all age groups.

Three children with sickle cell disease who had various combinations of severe hypertension, convulsion, and cerebral haemorrhage are presented. One child had elevated plasma renin activity while another had elevated 24-h urinary catecholamines. The aetiology of hypertension in sickle cell disease seems to be multifactorial. Recognition of this serious complication of sickle cell disease is important not only to avoid its consequences but also to avoid potentially dangerous diagnostic procedures.

A 6-year-old boy presented with a 4-month history of anorexia, weight loss and fatigue and was found to have tubulo-interstitial nephritis and uveitis (TINU) syndrome. After 2 months of corticosteroid therapy, resolution of the uveitis was almost complete but renal function showed only partial improvement. He was still in renal failure 6 months after diagnosis, but there was no relapse of the uveitis. Although the prognosis of TINU in children and adults is reported to be excellent, the outcome in young children can be less favourable, probably owing to delayed diagnosis and initiation of treatment.

Pediatric Services Division Dhahran Health Center Dhahran, Saudi Arabia *Address for reprints: Jahed M. Hamdan, M.D., Chief, Pediatric Services Division, Box 76, Dhahran, Saudi Arabia.