The Schoenlein-Henoch syndrome in childhood with particular reference to the occurance of nephritis.

The full syndrome of a purpuric skin eruption, intestinal bleeding and swollen joints was first described by Henoch (1874). Since that date there have been numerous papers about the syndrome. Gairdner (1948) reviewed the literature and grouped the condition with acute rheumatism, acute nephritis and polyarteritis nodosa. The name ' Schoenlein-Henoch Syndrome' used by Gairdner is adhered to in the present communication. Attention to the association of the syndrome with nephritis was drawn by Henoch (1899), and this was amplified by other authors (Macalister, 1906; Osler, 1914). Nephritis is now recognized as being the most serious complication of the disease. Gairdner (1948) found evidence of renal involvement in all but one of his 12 cases. Haematuria was reported in four of 44 cases described by Davis (1948) and in 10 of 20 cases described by Balf (1951). In neither of these papers was it made clear in all cases whether the haematuria was macroscopic only or whether microscopic haematuria was also included, and neither author mentioned whether complete and repeated urine analyses were made in their cases. The 44 cases reported by Davis included adults as well as children, the ages ranging from 4 to 71 years. Unfortunately he did not state the proportion of children in his series. No paper has been found which sets out specifically to determine the incidence of nephritis in a large series of cases. This paper describes the relapse rate in 40 cases of the Schoenlein-Henoch syndrome in children, with the incidence and progress of complicating nephritis. Material Only cases in which there was no doubt as to diagnosis, each exhibiting at least the typical rash of maculo-papules and petechiae and either abdominal or joint symptoms and having normal platelet counts, have been admitted to this study. All the patients attended either the Children's Hospital, Sheffield, or the paediatric department of the City General Hospital, Sheffield, during the five-year period of January, 1947, to December, 1951. The urine was examined microscopically and chemically regularly for at least two months after the start of the disease and one month after clinical recovery. Twenty-seven cases were followed-up for periods ranging from six months to five years after the onset of the disease. Of the remaining patients, in eight the disease was of too recent onset to include them in the group followed-up, and five could not be traced. In children whose urine contained more than 10 mg. % of protein and red blood cells and casts in the centrifuged deposit, 12-hour Addis counts were made, using the criteria of Giles (1947) for normality.