Henoch-Schönlein Purpura Nephritis: Key Symptoms and Clinical Features

Henoch-Schönlein Purpura (HSP) nephritis is a form of kidney inflammation that arises as a complication of Henoch-Schönlein purpura, a systemic vasculitis primarily affecting small blood vessels. This condition typically occurs in children but can also affect adults. Understanding its main characteristics is essential for early diagnosis and effective management.

Skin Manifestations: The Hallmark of HSP

Skin purpura is one of the most recognizable signs of this condition. Patients often develop palpable purpuric lesions—small, raised purple spots—mainly on the lower extremities and buttocks. These rashes are caused by inflammation and bleeding in the small blood vessels of the skin. Unlike simple bruising, the rash tends to appear in recurring waves, with new clusters emerging even as older ones begin to fade. This cyclical pattern helps differentiate HSP from other dermatological conditions.

Gastrointestinal Involvement: Abdominal Pain and Bleeding

Another critical feature is gastrointestinal involvement. Many patients experience abdominal pain, which can range from mild discomfort to severe, colicky episodes. This pain results from vasculitis affecting the blood vessels in the intestinal tract. In more serious cases, it can lead to bloody stools or melena due to gastrointestinal bleeding. Some individuals may also suffer from nausea, vomiting, or even intussusception—a rare but dangerous condition where part of the intestine slides into an adjacent segment.

Kidney Involvement: Signs of Nephritis

Renal complications define HSP nephritis and usually develop within weeks of the initial symptoms. The most common indicators include hematuria (blood in the urine), often visible as pink or cola-colored urine, and proteinuria, where excess protein leaks into the urine. These findings are typically detected through urinalysis during routine checkups.

Systemic Complications and Advanced Kidney Dysfunction

In more severe cases, patients may develop additional systemic issues such as edema—particularly around the eyes, hands, or feet—due to fluid retention. Hypertension is another frequent comorbidity, potentially exacerbating kidney damage if left uncontrolled. Alarmingly, a subset of patients progresses to acute kidney injury (AKI), marked by rising levels of serum creatinine and blood urea nitrogen (BUN). This signals impaired kidney filtration and requires prompt medical intervention.

Early detection and multidisciplinary care—including pediatric rheumatology, nephrology, and internal medicine—are crucial for preventing long-term renal damage. Monitoring urine output, blood pressure, and kidney function tests regularly can significantly improve patient outcomes. While many cases resolve spontaneously, especially in children, timely treatment is vital for those with persistent or severe symptoms.