Glucocorticoid-Responsive Hypertension in Henoch-Schönlein Purpura

Abstract

Henoch-Schonlein purpura (HSP) is a vasculitic syndrome which commonly involves small vessels of the skin, joints, intestines, and kidney. Renal involvement is the greatest cause of long-term morbidity and mortality and is identified by proteinuria and/or hematuria. Hypertension is an uncommon complication of renal involvement in HSP. Its occurrence is almost universally associated with other evidence of nephritis. Hypertension resistant to b-adrenergic blockade, calcium channel blocking agents, and vasodilators may occur early in the course of HSP in the absence of other evidence of renal disease. We report two children with Henoch-Schonlein purpura who had significant hypertension resistant to treatment with B-adrenergic blocking agents and vasodilators, one of whom had no other evidence of renal disease. In one child, the hypertension responded to therapy with captopril, suggesting a reninangiotensin mediated mechanism for the hypertension. In both children, initiation of corticosteroid therapy resulted in prompt resolution of hypertension, permitting the discontinuation of antihypertensive medications.