Henoch schonlein purpura--a 5-year review and proposed pathway.

Henoch Schonlein Purpura (HSP) is the commonest systemic vasculitis of childhood typically presenting with a palpable purpuric rash and frequently involving the renal system. We are the first group to clinically assess, critically analyse and subsequently revise a nurse led monitoring pathway for th...

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Autores principales:	Louise Watson, Amanda R W Richardson, Richard C L Holt, Caroline A Jones, Michael W Beresford
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2012
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/08e67773338e4adb98c8e00a6fb87a96
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spelling	oai:doaj.org-article:08e67773338e4adb98c8e00a6fb87a962021-11-18T07:31:07ZHenoch schonlein purpura--a 5-year review and proposed pathway.1932-620310.1371/journal.pone.0029512https://doaj.org/article/08e67773338e4adb98c8e00a6fb87a962012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22235302/?tool=EBIhttps://doaj.org/toc/1932-6203Henoch Schonlein Purpura (HSP) is the commonest systemic vasculitis of childhood typically presenting with a palpable purpuric rash and frequently involving the renal system. We are the first group to clinically assess, critically analyse and subsequently revise a nurse led monitoring pathway for this condition.A cohort of 102 children presenting with HSP to a secondary/tertiary level UK paediatric hospital over a five year period, were monitored using a nurse led care pathway. Using this cohort, the incidence (6.21 cases per 100,000 children per year) and natural disease course of HSP nephritis (46% initial renal inflammation; 9% subsequent renal referral; 1% renal biopsy and immunosuppression) was determined. Older patients were at higher risk of requiring a renal referral (renal referral 12.3 (8.4-13.5) years vs. normal outcome 6.0 (3.7-8.5) years; p<0.01). A normal urinalysis on day 7 had a 97% (confidence interval 90 to 99%) negative predictive value in predicting a normal renal outcome.Using this data and existing literature base, The Alder Hey Henoch Schonlein Purpura Pathway was developed, a revised pathway for the screening of poor renal outcome in HSP. This is based on a six-month monitoring period for all patients presenting with HSP, which importantly prioritises patients according to the urine findings on day 7 and thus intensively monitors those at higher risk of developing nephritis. The pathway could be easily adapted for use in different settings and resources.The introduction of a standardised pathway for the monitoring of HSP will facilitate the implementation of disease registries to further our understanding of the condition and permit future clinical trials.Louise WatsonAmanda R W RichardsonRichard C L HoltCaroline A JonesMichael W BeresfordPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 7, Iss 1, p e29512 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Louise Watson Amanda R W Richardson Richard C L Holt Caroline A Jones Michael W Beresford Henoch schonlein purpura--a 5-year review and proposed pathway.
description	Henoch Schonlein Purpura (HSP) is the commonest systemic vasculitis of childhood typically presenting with a palpable purpuric rash and frequently involving the renal system. We are the first group to clinically assess, critically analyse and subsequently revise a nurse led monitoring pathway for this condition.A cohort of 102 children presenting with HSP to a secondary/tertiary level UK paediatric hospital over a five year period, were monitored using a nurse led care pathway. Using this cohort, the incidence (6.21 cases per 100,000 children per year) and natural disease course of HSP nephritis (46% initial renal inflammation; 9% subsequent renal referral; 1% renal biopsy and immunosuppression) was determined. Older patients were at higher risk of requiring a renal referral (renal referral 12.3 (8.4-13.5) years vs. normal outcome 6.0 (3.7-8.5) years; p<0.01). A normal urinalysis on day 7 had a 97% (confidence interval 90 to 99%) negative predictive value in predicting a normal renal outcome.Using this data and existing literature base, The Alder Hey Henoch Schonlein Purpura Pathway was developed, a revised pathway for the screening of poor renal outcome in HSP. This is based on a six-month monitoring period for all patients presenting with HSP, which importantly prioritises patients according to the urine findings on day 7 and thus intensively monitors those at higher risk of developing nephritis. The pathway could be easily adapted for use in different settings and resources.The introduction of a standardised pathway for the monitoring of HSP will facilitate the implementation of disease registries to further our understanding of the condition and permit future clinical trials.
format	article
author	Louise Watson Amanda R W Richardson Richard C L Holt Caroline A Jones Michael W Beresford
author_facet	Louise Watson Amanda R W Richardson Richard C L Holt Caroline A Jones Michael W Beresford
author_sort	Louise Watson
title	Henoch schonlein purpura--a 5-year review and proposed pathway.
title_short	Henoch schonlein purpura--a 5-year review and proposed pathway.
title_full	Henoch schonlein purpura--a 5-year review and proposed pathway.
title_fullStr	Henoch schonlein purpura--a 5-year review and proposed pathway.
title_full_unstemmed	Henoch schonlein purpura--a 5-year review and proposed pathway.
title_sort	henoch schonlein purpura--a 5-year review and proposed pathway.
publisher	Public Library of Science (PLoS)
publishDate	2012
url	https://doaj.org/article/08e67773338e4adb98c8e00a6fb87a96
work_keys_str_mv	AT louisewatson henochschonleinpurpuraa5yearreviewandproposedpathway AT amandarwrichardson henochschonleinpurpuraa5yearreviewandproposedpathway AT richardclholt henochschonleinpurpuraa5yearreviewandproposedpathway AT carolineajones henochschonleinpurpuraa5yearreviewandproposedpathway AT michaelwberesford henochschonleinpurpuraa5yearreviewandproposedpathway
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Henoch schonlein purpura--a 5-year review and proposed pathway.

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