Treatment Options for Adult Henoch-Schönlein Purpura Nephritis

Understanding Henoch-Schönlein Purpura Nephritis in Adults

Henoch-Schönlein purpura (HSP) nephritis is a form of small-vessel vasculitis that primarily affects the kidneys, skin, joints, and gastrointestinal tract. While more common in children, adults who develop this condition often experience more severe symptoms and are at higher risk for long-term kidney damage. The core treatment strategy focuses on suppressing immune-mediated inflammation, protecting renal function, and managing systemic manifestations.

Core Treatment Principles and Lifestyle Adjustments

Immune modulation and inflammation control are central to managing adult HSP nephritis. Patients are advised to identify and avoid potential allergens that may trigger or worsen symptoms. Rest is strongly recommended during acute phases, with reduced physical activity to minimize stress on the body. Dietary modifications play a crucial role—patients should follow a low-sodium diet, strictly limit fluid intake, and avoid excessive consumption of red meat, shellfish, and other high-protein foods that may strain kidney function.

A balanced, nutrient-rich diet including vitamins and glucose supplements can support recovery. Antihistamines or other antiallergic medications are commonly prescribed. For those experiencing abdominal pain or gastrointestinal bleeding (such as melena), temporary fasting may be necessary, along with proton pump inhibitors (PPIs) to protect the gastric lining and reduce acid secretion.

Tailoring Medical Therapy Based on Disease Severity

Patients presenting with only microscopic hematuria or mild histological changes may experience spontaneous remission and require minimal intervention. In cases where proteinuria is mild and kidney function remains stable, physicians typically prescribe ACE inhibitors (e.g., lisinopril) or angiotensin receptor blockers (ARBs, e.g., losartan) to reduce protein loss and protect glomerular structure.

For moderate disease—characterized by moderate proteinuria, persistent hematuria, and relatively preserved renal function—corticosteroids such as prednisone are often introduced. These help suppress inflammatory responses within the glomeruli and improve clinical outcomes.

In more severe presentations, including nephrotic-range proteinuria, significant edema, hypoalbuminemia, and active urinary sediment, combination therapy becomes essential. Immunosuppressive agents like cyclophosphamide, tripterygium wilfordii (Thunder God Vine), or cyclosporine are added to steroid regimens to achieve better disease control and prevent rapid progression.

When renal function deteriorates quickly—progressing to acute kidney injury or even end-stage renal disease within weeks—pulse therapy with high-dose intravenous methylprednisolone or cyclophosphamide may be required. This aggressive approach aims to halt immune-mediated destruction of kidney tissue and stabilize organ function.

Complementary Role of Traditional Chinese Medicine

Pattern-Based Herbal Approaches

In traditional Chinese medicine (TCM), HSP nephritis is categorized into different syndromes based on clinical presentation. For the "excess heat" pattern, characterized by dry mouth, sore throat, flushed face, cough with phlegm, dark tea-colored urine, and bright red purpuric rash, treatment focuses on clearing heat and cooling the blood. A modified version of Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) is commonly used for its potent anti-inflammatory and hemostatic properties.

Conversely, patients exhibiting signs of qi deficiency—such as sallow complexion, fatigue, poor appetite, and pale pink purpura—are diagnosed with the "deficiency" pattern. In these cases, Guipi Tang (Restore the Spleen Decoction) is prescribed to strengthen spleen qi, enhance blood retention, and improve overall vitality.

Important Considerations and Prognosis

It's critical to understand that HSP nephritis involves systemic inflammation of small blood vessels and is not caused by bacterial infection. As such, antibiotics are ineffective and should not be used unless there is a confirmed concurrent infection.

While HSP is frequently seen in pediatric populations, adult-onset cases tend to carry a worse prognosis, with higher rates of persistent proteinuria, chronic kidney disease, and end-stage renal failure. Early diagnosis, close monitoring, and individualized treatment plans are vital for improving long-term outcomes.

Patients should seek care from nephrologists or rheumatologists experienced in autoimmune and vasculitic conditions. With timely intervention and comprehensive management—including Western medicine, supportive care, and potentially integrative therapies—many adults can achieve remission and maintain acceptable quality of life.