Prognosis of Henoch-Schönlein Purpura Nephritis: What Patients Need to Know

Henoch-Schönlein purpura nephritis (HSPN), a form of immunoglobulin A (IgA)-associated vasculitis affecting the kidneys, generally carries a favorable long-term prognosis, especially in pediatric populations. Children tend to recover more completely and experience fewer complications compared to adults. However, outcomes can vary significantly depending on clinical presentation, pathological findings, and response to treatment.

Clinical Variants and Their Impact on Prognosis

HSPN manifests in several clinical forms, each associated with different risk levels and recovery trajectories. These include:

• Isolated microscopic hematuria – typically linked with excellent outcomes and minimal long-term kidney damage.
• Hematuria with mild proteinuria – often resolves spontaneously, particularly in younger patients.
• Nephrotic-range proteinuria – signals more severe glomerular involvement and may require immunosuppressive therapy.
• Acute nephritic syndrome – characterized by hypertension, reduced kidney function, and active urinary sediment, indicating a more aggressive disease course.
• Chronic progressive nephritis – rare but concerning, this form may lead to gradual loss of kidney function over time.

Pathological Findings: The Key to Predicting Outcomes

Renal biopsy remains the gold standard for assessing disease severity and forecasting prognosis in HSPN. Histopathological classification, particularly the extent of glomerular injury and crescent formation, plays a decisive role in determining long-term kidney health.

The Role of Crescentic Glomerulonephritis

Patients presenting with acute nephritic features often show significant histological changes, including the development of cellular or fibrocellular crescents in a substantial proportion of glomeruli. The presence of crescents—especially when involving more than 50% of glomeruli—is strongly correlated with poorer renal outcomes, including an increased risk of chronic kidney disease (CKD) or end-stage renal disease (ESRD).

When to Consider Kidney Biopsy

Early diagnostic intervention is critical for individuals exhibiting persistent or heavy proteinuria (greater than 1 g/day), recurrent gross hematuria, impaired kidney function, or hypertension. A timely kidney biopsy allows clinicians to:

• Determine the exact class of IgA nephropathy according to standardized scoring systems (e.g., Oxford Classification).
• Assess the degree of tubulointerstitial fibrosis and glomerulosclerosis.
• Tailor immunosuppressive or supportive therapies based on individual risk profiles.

In summary, while most patients with HSPN—particularly children—enjoy full recovery without lasting consequences, vigilant monitoring and personalized management are essential for those with high-risk features. Advances in pathology-guided treatment have significantly improved prognostic accuracy and patient outcomes in recent years.