How to Manage Henoch-Schönlein Purpura Nephritis: Symptoms, Treatment, and Lifestyle Tips
Henoch-Schönlein purpura (HSP) nephritis, a form of glomerulonephritis triggered by an autoimmune response, often follows a self-limiting course—especially in cases presenting with isolated microscopic hematuria without proteinuria. In such mild forms, no specific medical intervention is typically required, as the condition tends to resolve on its own over time. However, close monitoring through regular urinalysis and blood pressure checks is recommended to ensure kidney function remains stable.
Understanding Proteinuria in HSP Nephritis
A significant number of patients with HSP do develop varying degrees of proteinuria, which indicates more active kidney involvement. For individuals with mild protein excretion, conservative management may be sufficient. This includes antihistamine therapy—such as cetirizine—to help control underlying allergic components, along with medications like rutin compounds that support vascular integrity. As skin rashes improve, renal symptoms often follow suit, reducing the immediate need for invasive procedures like kidney biopsy.
When Is a Kidney Biopsy Necessary?
If a patient experiences persistent or heavy proteinuria, especially approaching nephrotic range levels, a renal biopsy becomes essential for accurate diagnosis and treatment planning. The biopsy helps identify the extent of glomerular damage and guides clinicians in determining whether immunosuppressive therapy is warranted.
Interpreting Biopsy Results and Tailoring Treatment
Minimal Mesangial Proliferation: If histopathology reveals only mild mesangial hyperplasia, aggressive treatment may not be necessary. In these cases, physicians often opt for supportive care, including blood pressure control with ACE inhibitors or ARBs, which also help reduce protein leakage.
Presence of Crescents: However, if the biopsy shows crescentic glomerulonephritis—particularly when more than 50% of glomeruli are affected—treatment intensity increases significantly. Such cases usually require high-dose corticosteroids combined with immunosuppressants like cyclophosphamide or mycophenolate mofetil to halt disease progression and preserve long-term kidney function.
Lifestyle and Dietary Management for Long-Term Health
Diet plays a crucial role in managing HSP nephritis, especially in chronic or recurrent cases. Patients should follow evidence-based dietary principles for chronic kidney disease (CKD), including:
- Low-sodium intake to manage hypertension and reduce fluid retention.
- High-quality, low-protein diet to minimize metabolic strain on the kidneys while maintaining adequate nutrition.
- Avoidance of known allergens and potential triggers, given the immune-mediated nature of HSP.
Additionally, preventing infections is vital, as upper respiratory tract infections and other illnesses can exacerbate inflammation and trigger disease relapse. Practicing good hygiene, staying up to date with vaccinations (as approved by a healthcare provider), and avoiding crowded environments during peak illness seasons are practical preventive steps.
Prognosis and Follow-Up
Most children and many adults with HSP nephritis have a favorable prognosis, particularly when diagnosed early and managed appropriately. Regular follow-up with a nephrologist, including monitoring of urine protein-to-creatinine ratio, serum creatinine, and blood pressure, ensures timely detection of any worsening trends. With comprehensive care—including medication, diet, and lifestyle adjustments—patients can achieve remission and maintain healthy kidney function over time.