Renal infarction in a child with Henoch-Schönlein purpura
| Autor: | Valentina Gracchi, Jaap W. Groothoff, Krijn P. van Lienden, Jean-Claude Davin, Sophie Ploos van Amstel, Antonia H. Bouts |
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| Přispěvatelé: | Radiology and Nuclear Medicine, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam Public Health, Other Research, Paediatric Nephrology, Other departments |
| Rok vydání: | 2014 |
| Předmět: |
Male
medicine.medical_specialty Pathology Henoch-Schonlein purpura IgA Vasculitis Infarction Kidney Gastroenterology Renal Artery Predictive Value of Tests Risk Factors Internal medicine medicine Humans Protein S deficiency Microhematuria medicine.diagnostic_test business.industry Angiography Digital Subtraction medicine.disease medicine.icd_9_cm_classification Purpura Nephrology Child Preschool Angiography Skin biopsy Renal biopsy medicine.symptom business |
| Zdroj: | Kidney international, 85(2). Nature Publishing Group |
| ISSN: | 1523-1755 0085-2538 |
| Popis: | A 5-year-old boy with no relevant medical history presented with severe abdominal pain and purpura on the lower extremities, consistent with the diagnosis of Henoch–Schonlein purpura. Kidney function, blood pressure, and urinary parameters were normal. Repeated ultrasound investigations showed no evidence of intussusception and no renal abnormalities. The severity of the abdominal symptoms led to perform a digital subtraction angiography a week later, to rule out a vasculitis of medium- or large-sized arteries. No artery lesion was seen, but an infarction was present in the lower pole of the left kidney (Figure 1). At that moment, platelet count was decreasing (464 × 109/l at admission; 382 × 109/l on the day of angiography) and inflammatory parameters were high (C-reactive protein 93.9 mg/l; leukocytes 19.1 × 109/l). There was no evidence of volume depletion and no polycythemia. Blood pressure was normal. After 2 days, microhematuria was detected (>20 erythrocytes/high-power field). Genetic risk factors for thromboembolism, including protein C and protein S deficiency, activated protein C cell resistance and factor II mutation, were excluded. Lupus anticoagulant antibodies were negative. A diagnosis of Henoch–Schonlein purpura was established by immunoglobulin-A staining on skin biopsy, and was subsequently confirmed on renal biopsy, performed because of the onset of moderate transient proteinuria (1.48 g/l). |
| Databáze: | OpenAIRE |
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