What Happens When Henoch-Schönlein Purpura Nephritis Recurs in Children?

Henoch-Schönlein Purpura (HSP) nephritis is generally considered one of the more favorable types of chronic glomerulonephritis in terms of long-term prognosis, especially in pediatric cases. However, despite its relatively positive outlook, it remains a form of chronic kidney inflammation, meaning the condition can persist over time and may experience periods of relapse. Understanding the implications of a recurrence is crucial for parents, caregivers, and healthcare providers to ensure timely intervention and proper management.

Understanding Disease Relapse in HSP Nephritis

Even after successful treatment and apparent remission, some children may experience a resurgence of symptoms. One of the most common triggers for relapse includes infections—particularly upper respiratory tract infections—or re-exposure to certain foods or allergens that may have initially contributed to the onset of HSP. Since HSP is fundamentally a systemic small-vessel vasculitis, any reappearance of skin rash (palpable purpura) should be taken seriously. The return of cutaneous symptoms often signals renewed inflammatory activity within the blood vessels, which may extend to the kidneys and reignite renal involvement.

Key Signs of Kidney Involvement During Relapse

In many cases, kidney flare-ups occur even without visible skin manifestations. This makes ongoing monitoring essential, particularly for children with a prior history of nephritis. The primary indicators of renal relapse include:

Worsening hematuria – A shift from microscopic to persistent or recurrent gross hematuria (visible blood in urine)
Increased proteinuria – Higher levels of protein in the urine, measurable through 24-hour urine tests or spot protein-to-creatinine ratios
New or returning edema – Swelling in the face, hands, feet, or abdomen due to fluid retention

These changes suggest that the glomeruli—the filtering units of the kidneys—are undergoing renewed injury, potentially leading to progressive scarring if left untreated.

Systemic Complications Beyond the Kidneys

Some children may present with more complex relapses involving multiple systems. In addition to urinary abnormalities, clinicians may observe:

Elevated blood pressure – Hypertension can develop as a result of impaired kidney function and fluid overload. Uncontrolled high blood pressure further damages the kidneys and increases cardiovascular risk over time.

Declining renal function – Measured by rising serum creatinine or reduced estimated glomerular filtration rate (eGFR), this indicates that the kidneys are losing their ability to filter waste effectively. While rare in mild cases, significant functional decline requires aggressive management to prevent long-term complications such as chronic kidney disease (CKD).

Why Early Detection Matters

Regular follow-up appointments, routine urinalysis, and blood pressure checks are vital during remission. Parents should be vigilant for subtle signs like foamy urine (indicating protein), dark-colored urine, fatigue, or unexplained swelling. Prompt medical evaluation at the first sign of recurrence can make a significant difference in preserving kidney health.

In conclusion, while HSP nephritis in children often has a favorable trajectory, relapses can and do happen. Awareness of potential triggers and symptoms allows for early intervention, minimizing long-term damage. With consistent monitoring and appropriate treatment, most children can achieve sustained remission and maintain normal kidney function into adulthood.