eMedicine Specialties > Pediatrics: General Medicine > Nephrology

Henoch-Schonlein Purpura: Follow-up

Author: Noah S Scheinfeld, MD, JD, FAAD, Assistant Clinical Professor, Department of Dermatology, Columbia University; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, New York Eye and Ear Infirmary; Private Practice
Coauthor(s): Elena L Jones, MD, Clinical Assistant Professor of Dermatology, College of Physicians and Surgeons of Columbia University; Clinic Chief, Department of Dermatology, St Luke's-Roosevelt Hospital Center
Contributor Information and Disclosures

Updated: Sep 28, 2009

Follow-up

Further Inpatient Care

  • Management of Henoch-Schoenlein purpura (HSP) includes adequate hydration; immediate discontinuation of any exposure to antigenic stimulants (ie, drugs); and follow-up each week for the first month, every other week for the second month, and monthly thereafter until abnormal urinary findings subside.

Further Outpatient Care

  • Monitor kidney function in patients who initially had kidney involvement.

Inpatient & Outpatient Medications

  • Once the initial course of prednisone is administered, additional prednisone appears to have no role.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) can be administered for joint problems. Because of Reye syndrome, the use of NSAIDs should be discussed with the patient's physician.

Complications

  • Myocardial infarction
  • Pulmonary hemorrhage
  • Pleural effusion
  • Intussusception
  • GI bleeding
  • Bowel infarction
  • Renal failure
  • Hematuria
  • Proteinuria
  • Seizures
  • Mononeuropathies
  • Recurrence of symptoms, specifically those of renal impairment (rare)

Prognosis

  • The prognosis is excellent; however, complications arise in rare cases.
  • The disease usually spontaneously resolves.
  • Children younger than 3 years have a shorter, milder course than that of other patients and fewer recurrences than other patients.
  • A clinical course with complete resolution of the disease usually occurs in patients with the following:
    • Mild kidney involvement
    • No neurologic complications
    • Disease that lasts less than 4-6 weeks initially
  • Recurrences occur in 50% of patients within 6 weeks but can happen as late as 7 years after the initial disease. The higher the number of recurrences, the higher the likelihood of permanent renal damage.
  • Persistent renal disease develops in 2-5% of patients (<1% develop ESRF). Age older than 6 years is a negative prognostic indicator.
  • Predictors of serious nephropathy or ESRF include the following:
    • Bloody stools
    • Rash persistence
    • Signs of nephritis or nephrotic syndrome (progresses to ESRF within 10 years in 50% of patients)
    • Renal biopsy with extensive glomerular crescents

Patient Education

  • Inform patients that the disease is most likely to resolve with few residual adverse effects but that relapses are possible. Explain that severe kidney involvement is rare, but if it does occur, they may require aggressive treatment.
  • For excellent patient education resources, visit eMedicine's Kidneys and Urinary System Center. Also, see eMedicine's patient education article Blood in the Urine.

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnosis Henoch-Schoenlein purpura (HSP) and monitor patients appropriately
  • Failure to adequately monitor patients with Henoch-Schoenlein purpura and renal involvement for signs of renal dysfunction and failure
  • Failure to deal with rare complications involving the kidneys, intestines, CNS, or joints

Special Concerns

  • All pregnant women with even mild renal symptoms at Henoch-Schoenlein purpura onset should be carefully observed during and after pregnancy.
  • In adults with Henoch-Schoenlein purpura, permanent renal involvement is not uncommon.
    • Hematuria at disease onset and persistence of renal manifestations during the occurrence of Henoch-Schoenlein purpura can be significant predictors of possible development of renal sequelae.
    • These manifestations plus other features, such as onset in summer, anemia at disease onset, or relapses of the disease, may predict the development of renal sequelae in most patients.
  • Henoch-Schoenlein purpura may mimic an abdominal emergency and, in its severest form, result in small-bowel infarction and/or perforation.
  • When terminal renal failure develops, long-term hemodialysis should be instituted until a kidney is available for transplantation. Mesangial deposits of IgA are common in the graft, but they rarely lead to clinical manifestations of recurrent glomerulonephritis.
  • Medications can cause Henoch-Schoenlein purpura. Losartan therapy has been reported to induce Henoch-Schoenlein purpura.
  • Children who have demonstrated renal manifestations in the acute phase and continue to have hematuria or proteinuria should be examined every 3-6 months because renal failure or hypertension can develop up to 10 years after disease onset.
  • When patients present with nephrotic syndrome, hypertension, and rapidly deteriorating renal function, biopsy frequently shows circumferential crescents in most of the glomeruli. Approximately 60% of patients develop renal failure, either in the acute phase of the disease or after an interval of several years.
 


More on Henoch-Schonlein Purpura

Overview: Henoch-Schonlein Purpura
Differential Diagnoses & Workup: Henoch-Schonlein Purpura
Treatment & Medication: Henoch-Schonlein Purpura
Follow-up: Henoch-Schonlein Purpura
Multimedia: Henoch-Schonlein Purpura
References
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Further Reading

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Keywords

Henoch Schönlein purpura, Henoch-Schönlein purpura, Henoch Schonlein purpura, Henoch-Schonlein purpura, Henoch Schoenlein purpura, Henoch-Schoenlein purpura, HSP, allergic purpura, Henoch's purpura, Schönlein purpura, Schönlein's purpura, Schönlein disease, Schönlein's disease, Henoch-Schönlein purpura, Henoch-Schönlein syndrome, Schönlein-Henoch syndrome, vascular purpura, acute vascular purpura, anaphylactoid purpura, hemorrhagic exudative erythema, purpura nervosa, purpura rheumatica, rheumatocelis, purpura fulminans, purpura hemorrhagica, nonthrombocytopenic purpura, rheumatoid purpura, allergic purpura

hemorrhagic capillary toxicosis, nonthrombocytopenic idiopathic purpura, peliosis rheumatica, rheumatic purpura, acute hemorrhagic edema of infancy, AHEI, postinfectious cockade purpura, Finkelstein disease, Finkelstein's disease, Seidelmayer syndrome, Seidelmayer's syndrome, infantile postinfectious irislike purpura and edema, vasculitis, arthritis, cutaneous purpura, orchitis, nephritis, species, adenoviruses, Epstein-Barr virus, EBV, parvoviruses, varicella, hypertension, proteinuria, mononucleosis, group A streptococcal infection, hepatitis, varicella-zoster infection

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Contributor Information and Disclosures

Author

Noah S Scheinfeld, MD, JD, FAAD, Assistant Clinical Professor, Department of Dermatology, Columbia University; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, New York Eye and Ear Infirmary; Private Practice
Noah S Scheinfeld, MD, JD, FAAD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Optigenex Consulting fee Independent contractor

Coauthor(s)

Elena L Jones, MD, Clinical Assistant Professor of Dermatology, College of Physicians and Surgeons of Columbia University; Clinic Chief, Department of Dermatology, St Luke's-Roosevelt Hospital Center
Disclosure: Nothing to disclose.

Medical Editor

Richard Neiberger, MD, PhD, Director of Pediatric Renal Stone Disease Clinic, Associate Professor, Department of Pediatrics, Division of Nephrology, University of Florida College of Medicine and Shands Hospital
Richard Neiberger, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Federation for Medical Research, American Medical Association, American Society of Nephrology, American Society of Pediatric Nephrology, Christian Medical & Dental Society, Florida Medical Association, International Society for Peritoneal Dialysis, International Society of Nephrology, National Kidney Foundation, New York Academy of Sciences, Shock Society, Sigma Xi, Southern Medical Association, Southern Society for Pediatric Research, and Southwest Pediatric Nephrology Study Group
Disclosure: The Osler Institute Honoraria Speaking and teaching

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Adrian Spitzer, MD, Professor, Department of Pediatrics, Albert Einstein College of Medicine; Director of NIH Training Program, Children's Hospital at Montefiore Medical Center
Adrian Spitzer, MD is a member of the following medical societies: American Academy of Pediatrics, American Federation for Medical Research, American Pediatric Society, American Society of Nephrology, American Society of Pediatric Nephrology, International Society of Nephrology, and Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Howard Trachtman, MD, Program Director, Pediatrics Research, Schneider Children's Hospital, Department of Pediatrics, Division of Nephrology, Professor, Albert Einstein College of Medicine
Howard Trachtman, MD is a member of the following medical societies: American Society of Hypertension, American Society of Nephrology, American Society of Pediatric Nephrology, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Chief Editor

Craig B Langman, MD, The Isaac A Abt, MD, Professor of Kidney Diseases, Feinberg School of Medicine, Northwestern University; Division Head of Kidney Diseases, Children's Memorial Hospital, Chicago
Craig B Langman, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Nephrology, and International Society of Nephrology
Disclosure: Amgen Grant/research funds None; Altus Pharmaceuticals Grant/research funds None; Genzyme Grant/research funds None; Merck Grant/research funds None; NIH Grant/research funds None

 
 
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