Symptoms of Henoch-Schönlein Purpura Nephritis: What You Need to Know

Henoch-Schönlein purpura nephritis (HSPN) is a form of kidney inflammation that occurs as a complication of Henoch-Schönlein purpura, a condition characterized by blood vessel inflammation. This autoimmune response primarily affects small blood vessels and can lead to a range of symptoms affecting the skin, gastrointestinal tract, joints, and kidneys.

Skin Manifestations: The First Warning Signs

One of the most recognizable features of HSPN is the appearance of palpable purpura—small, raised purple or red spots caused by bleeding under the skin. These lesions typically develop on the lower extremities, especially on the backs of the legs and around the ankles, and are usually symmetrical in distribution. Unlike simple bruising, these spots do not fade when pressed and often cluster around joints. While they are most common in children and adolescents, adults can also be affected. Early recognition of this rash can prompt timely medical evaluation and prevent progression to more serious complications.

Kidney Involvement: Detecting Urinary Abnormalities

Kidney involvement is a hallmark of HSPN and often becomes evident through urinalysis. Many patients present with microscopic hematuria, meaning red blood cells are visible only under a microscope. In some cases, the blood is abundant enough to cause gross hematuria, turning the urine visibly pink, red, or tea-colored. Additionally, proteinuria—excess protein in the urine—is frequently observed and may indicate glomerular damage. If left unmonitored, persistent protein loss can progress to nephrotic-range levels, increasing the risk of long-term renal impairment.

Monitoring Kidney Function

Regular monitoring of kidney function through blood tests (such as serum creatinine and estimated glomerular filtration rate) is crucial for assessing disease severity. Some patients may experience mild kidney dysfunction, while others develop more pronounced signs of glomerulonephritis. Early intervention can significantly improve outcomes, making routine follow-up essential for anyone diagnosed with HSP.

Gastrointestinal and Systemic Symptoms

Beyond skin and kidney issues, HSPN can involve other organ systems. Gastrointestinal symptoms such as abdominal pain, nausea, vomiting, and even gastrointestinal bleeding are not uncommon. The abdominal pain is often colicky and may be accompanied by bloody stools. In some cases, intussusception—a serious condition where part of the intestine slides into an adjacent segment—can occur, particularly in younger patients.

Joint and Generalized Discomfort

Arthralgia (joint pain) and mild arthritis are also frequently reported, typically affecting the knees and ankles. These symptoms are usually temporary and resolve without permanent joint damage. Patients may also experience low-grade fever, fatigue, and general malaise during the acute phase of the illness.

Recognizing the full spectrum of HSPN symptoms allows for earlier diagnosis and better management. Because the condition can mimic other diseases, a comprehensive clinical evaluation—including skin assessment, urinalysis, and sometimes kidney biopsy—is key to confirming the diagnosis. With proper care, most individuals recover well, though ongoing monitoring is recommended to catch any potential relapses or chronic kidney issues early.