Symptoms of Henoch-Schönlein Purpura Nephritis in Children

Henoch-Schönlein purpura (HSP) nephritis is a relatively common pediatric condition encountered in clinical practice. When healthcare providers evaluate children presenting with widespread skin rashes, abdominal pain, joint swelling and discomfort, or other systemic complications—including neurological or pulmonary manifestations—HSP should be considered as a primary differential diagnosis. Among these cases, a subset will progress to involve the kidneys, leading to what is known as HSP nephritis.

Recognizing Early Signs of HSP Nephritis

One of the hallmark features of HSP is palpable purpura—small, raised purple spots typically appearing on the lower extremities and buttocks. However, when the disease affects the kidneys, additional symptoms may emerge. These include hematuria (blood in the urine), proteinuria (excess protein in the urine), and in more severe cases, reduced kidney function. Parents may notice that their child's urine appears darker or foamy, which can signal underlying renal involvement.

Diagnostic Approach and Clinical Evaluation

Once HSP nephritis is suspected, a comprehensive diagnostic workup becomes essential. Physicians typically order urinalysis to detect abnormal levels of red and white blood cells, as well as elevated protein excretion. Blood tests are also performed to assess kidney function, including serum creatinine and estimated glomerular filtration rate (eGFR).

Immune system markers such as immunoglobulin A (IgA) levels are often evaluated, given that HSP is an IgA-mediated vasculitis. In some instances, especially when kidney damage appears significant or progressive, a renal biopsy may be recommended. This procedure allows for a definitive diagnosis by revealing characteristic IgA deposits in the glomeruli, confirming the presence and extent of nephritis.

Understanding Disease Severity and Prognosis

The severity of HSP nephritis varies widely among children. While many experience mild, self-limiting symptoms, others may develop chronic kidney disease if not properly managed. Close monitoring through regular follow-ups, urine testing, and blood pressure checks is crucial to prevent long-term complications.

Early detection and tailored treatment plans—often involving corticosteroids or immunosuppressive agents in more severe cases—can significantly improve outcomes. With timely intervention and multidisciplinary care, most children recover fully, underscoring the importance of awareness and prompt medical evaluation when warning signs arise.