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 mild cases. When the condition presents with isolated microscopic hematuria and no proteinuria, medical intervention may not be necessary. Many patients experience spontaneous recovery as the underlying immune process resolves on its own. This is particularly true in children, who typically have a more favorable prognosis compared to adults.

When Is Treatment Necessary?

While some individuals only exhibit blood in the urine, the majority of HSP patients develop varying degrees of proteinuria. In cases of mild protein leakage, conservative management focusing on allergy control can be effective. Antihistamines such as cetirizine or bioflavonoid combinations like rutin may help reduce vascular inflammation and support symptom improvement. As skin rashes begin to fade, renal involvement often stabilizes concurrently, indicating that aggressive treatment isn't always required.

Assessing Kidney Damage: The Role of Biopsy

If a patient experiences persistent or heavy proteinuria, a kidney biopsy becomes essential for accurate diagnosis and treatment planning. The histopathological findings from the biopsy guide clinical decisions and help determine the severity of glomerular injury. For instance, if the biopsy reveals only mild mesangial proliferation, doctors may opt for close monitoring rather than immediate immunosuppressive therapy.

Advanced Cases: Immunosuppressive Therapy and Monitoring

However, when the biopsy shows crescentic glomerulonephritis—particularly with more than 50% crescents—treatment strategies shift significantly. These severe forms often require combination therapy, including corticosteroids and additional immunosuppressants such as cyclophosphamide or mycophenolate mofetil. Early and aggressive intervention in these cases can help preserve kidney function and prevent progression to chronic kidney disease.

Preventing Triggers and Supporting Recovery

Infection prevention plays a critical role in managing HSP nephritis. Patients should take steps to avoid respiratory infections, practice good hygiene, and stay up to date with vaccinations (excluding live vaccines during immunosuppression). Given the immune-mediated nature of the disease, minimizing exposure to known allergens—such as certain foods, medications, or environmental triggers—is also highly recommended.

Dietary Recommendations for Kidney Health

Nutrition is another cornerstone of long-term management. Following a kidney-friendly diet helps reduce the workload on the kidneys and supports overall well-being. A low-sodium diet is crucial to control blood pressure and minimize fluid retention. Additionally, a high-quality, low-protein diet—with proteins sourced from lean meats, eggs, and dairy—can slow the progression of kidney damage. Staying hydrated and avoiding processed foods rich in phosphorus and potassium is equally important, especially in moderate to advanced stages.

Ultimately, successful management of HSP nephritis depends on early detection, individualized treatment plans, and consistent follow-up. With proper care, most patients achieve remission and maintain stable kidney function over time. Regular urine tests, blood pressure checks, and nephrology consultations are key to ensuring long-term health and preventing complications.