While the clinical impact of the impaired immune response, commonly described in chronic dialysis patients, is still a matter of discussion, it is usually considered that
immunological diseases tend to become progressively less active after the start of regular
renal replacement therapy (RRT). We reported a case of
Henoch-Schonlein Purpura in a 51-year-old male, on RRT for 20 years, 8 on dialysis and 12 with renal graft, because of
ESRD of unknown origin (chronic
glomerulonephritis?). The acute onset of the syndrome, presenting purpuric
rash, abdominal discomfort and asymmetric
joint pain with
edema and local signs of acute
inflammation, was followed by several relapses over a 2 years period. This biopsy proven diagnosis offered an explanation for his
chronic renal failure; furthermore, we conclude that, possibly because of the usually good correction of uremic immunodepression by efficient dialysis (this patient's Kt/V ranged from 1.1 to 1.3 according to Lowrie's formula), the possibility of
immune diseases should be carefully considered even in long long-term RRT patients.