Symptoms and Clinical Manifests of Henoch-Schönlein Purpura Nephritis

Henoch-Schönlein purpura nephritis (HSPN) is a systemic vasculitis that primarily affects small blood vessels and often follows an upper respiratory infection. It is most commonly seen in children but can also occur in adults. The condition presents with both extrarenal and renal manifestations, making early recognition essential for effective management and preventing long-term kidney damage.

Extrarenal Symptoms of HSPN

The hallmark of HSPN lies in its extrarenal features, which typically precede or accompany kidney involvement. One of the most distinctive signs is cutaneous purpura—characterized by non-blanching, palpable red-to-purple spots that predominantly appear on the extensor surfaces of the lower limbs. These petechiae are symmetrically distributed and may coalesce into larger patches in more severe cases. Unlike other rashes, they do not fade under pressure, which helps differentiate them from non-vasculitic skin conditions.

Musculoskeletal Involvement

A significant number of patients experience joint pain, particularly affecting weight-bearing joints such as the ankles and knees. This arthralgia can range from mild discomfort to acute inflammation resembling arthritis, although permanent joint damage is rare. The pain is usually transient and resolves without sequelae, but it can significantly impact mobility during active phases of the disease.

Gastrointestinal and Neurological Complications

Gastrointestinal symptoms are another critical component of HSPN. Patients may develop abdominal pain, nausea, vomiting, and in some cases, gastrointestinal bleeding leading to melena or hematochezia. These symptoms result from vasculitic involvement of the intestinal tract and require careful monitoring to rule out complications like intussusception, especially in pediatric cases.

In rare instances, central nervous system involvement may occur. Neurological manifestations can include headaches, seizures, altered mental status, or even coma. Though uncommon, these symptoms indicate a more severe systemic form of the disease and demand immediate medical evaluation.

Renal Manifestations: Key Indicators of Kidney Involvement

Kidney involvement defines the progression from simple Henoch-Schönlein purpura to full-blown purpuric nephritis. The primary renal signs include hematuria, proteinuria, edema, hypertension, and impaired kidney function. Microscopic hematuria is the most common finding, observed in up to 93.3% of affected individuals. Approximately 43.3% may progress to macroscopic hematuria, where blood is visibly present in the urine.

Proteinuria and Hypertension

Proteinuria varies in severity—from mild to nephrotic-range—and correlates with the extent of glomerular injury. Persistent protein loss in the urine increases the risk of chronic kidney disease if left untreated. Additionally, elevated blood pressure is frequently observed and must be closely monitored, as uncontrolled hypertension can accelerate renal deterioration.

Edema and Renal Function Abnormalities

Edema, particularly around the eyes and lower extremities, occurs due to reduced serum albumin levels and sodium retention. Laboratory tests often reveal abnormal creatinine clearance and elevated serum creatinine, indicating compromised glomerular filtration rate (GFR). Early detection through urinalysis and renal function panels is crucial for timely intervention.

In summary, recognizing the dual spectrum of extrarenal and renal symptoms in Henoch-Schönlein purpura nephritis enables clinicians to initiate appropriate therapy promptly. Awareness among patients and healthcare providers about these diverse clinical expressions improves outcomes and reduces the likelihood of irreversible kidney damage.