Henoch-Schönlein Purpura Nephritis in Childhood

Henoch-Schönlein purpura is one of the most common causes of systemic vasculitis. Henoch–Schönlein purpura typically affects children between the age of 3 and 10 years. The aetiology is unknown. Diagnosis includes palpable purpura (essential) in the presence of diffuse abdominal pain, acute arthritis/arthralgia, renal involvement characterized by haematuria and/or proteinuria (Ozen et al., 2006) and skin biopsy showing predominant IgA deposition in the walls of cutaneous vessels. In the majority of cases it is a self-limiting disease. Therefore, up to 40% of children with Henoch–Schönlein purpura require hospitalization for management of acute disease manifestations which may include nephritis, hypertension, severe pain, gastrointestinal bleeding or arthritis. Purpura occurs in all cases, joint pains and arthritis in 80% of cases, and abdominal pain in 62% of cases. The purpura typically appears on the legs and buttocks (Fig.1), but may also be seen on the arms, face and trunk. The abdominal pain is colicky, and may be accompanied by nausea, vomiting, constipation or diarrhea. There may be blood or mucus in the stools. Sometime finding includes a gastrointestinal haemorrhage, occurring in 33% of cases, due to intussusceptions (Saulsbury, 1999). The joints involved tend to be the ankles, knees, and elbows but arthritis in the hands and feet is possible; the arthritis is non-erosive and hence causes no permanent deformity. Problems in other organs, such as the central nervous system (brain and spinal cord) and lungs may occur, but much less commonly than the skin, bowel and kidneys (Saulsbury, 2001)