How to Treat Henoch-Schönlein Purpura-Induced Nephritis: A Comprehensive Guide

Henoch-Schönlein purpura (HSP) is a relatively common condition in dermatology, but it's more than just a skin disorder—it's fundamentally a form of small-vessel vasculitis. When this inflammatory process extends to the kidneys, it leads to what is known as HSP nephritis or IgA vasculitis with nephritic involvement. This complication can range from mild urinary abnormalities to severe kidney damage, making early diagnosis and tailored treatment essential for preserving renal function.

Understanding HSP Nephritis and Its Clinical Spectrum

HSP nephritis occurs when immune complexes—particularly those containing immunoglobulin A (IgA)—deposit in the glomeruli of the kidneys, triggering inflammation and injury. The clinical presentation varies significantly among patients. Some may only exhibit microscopic hematuria or mild proteinuria, while others develop full-blown nephrotic syndrome characterized by heavy protein loss, low blood albumin, swelling, and high cholesterol.

Mild Cases: Conservative Management with ACE Inhibitors and Supportive Therapies

In cases where kidney involvement is mild—such as isolated or minimal proteinuria without nephrotic features—the primary focus is on controlling symptoms and protecting kidney function. Alongside managing the underlying HSP, physicians often prescribe angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs). These medications help reduce proteinuria and slow down glomerular damage by lowering intraglomerular pressure.

Additionally, certain traditional Chinese medicine formulations like Bailing Capsules (containing Cordyceps sinensis extract) and Nephritis Recovery Tablets are commonly used as adjunctive therapies in some regions. While more research is needed to fully validate their efficacy through Western clinical trials, these supplements are believed to support immune regulation and promote renal repair.

Severe Cases: Immunosuppressive Therapy and Renal Biopsy Guidance

When HSP nephritis progresses to nephrotic-range proteinuria or shows signs of rapidly declining kidney function, a more aggressive approach is warranted. In such instances, a kidney biopsy is strongly recommended to determine the exact histopathological pattern. Common findings include mesangial proliferative glomerulonephritis, early membranous nephropathy, or minimal change disease—all of which respond differently to treatment.

The cornerstone of therapy in moderate to severe cases typically involves corticosteroids, a class of potent immunosuppressants. Glucocorticoids like prednisone have demonstrated significant effectiveness in reducing inflammation and stabilizing kidney function in HSP-related nephritis. Their ability to suppress abnormal immune responses helps prevent further IgA deposition and glomerular scarring.

Combination Immunosuppression for Resistant or Complex Cases

Although corticosteroids are often effective, certain patients—especially those with crescentic changes or severe histological damage—may require additional immunosuppressive agents. In these rare but serious scenarios, combination therapy using drugs such as cyclophosphamide, mycophenolate mofetil, or azathioprine may be introduced alongside steroids to enhance therapeutic outcomes.

This dual-agent strategy aims to achieve faster remission, reduce steroid dependence, and lower the risk of long-term complications. Treatment duration and intensity are carefully adjusted based on individual response, biopsy results, and ongoing laboratory monitoring.

Prognosis and Long-Term Monitoring

Most children with HSP nephritis recover completely, especially if treated early. However, adults tend to have a higher risk of persistent kidney issues or progression to chronic kidney disease. Therefore, regular follow-up—including urine tests, blood pressure checks, and serum creatinine monitoring—is crucial even after apparent recovery.

Lifestyle modifications such as a low-salt diet, adequate hydration, and avoiding nephrotoxic substances also play an important supportive role in maintaining kidney health during and after treatment.