Treatment Approaches for Henoch-Schönlein Purpura Nephritis

Understanding Henoch-Schönlein Purpura Nephritis and Its Management

Henoch-Schönlein purpura (HSP) nephritis is a type of immune-mediated vasculitis that primarily affects small blood vessels, often leading to kidney involvement. Effective treatment focuses on symptom control, preventing complications, and preserving renal function. Early diagnosis and personalized care are essential for improving long-term outcomes.

Core Principles of Treatment

Managing HSP nephritis involves a comprehensive approach tailored to the severity of symptoms and laboratory findings. The primary goals include reducing inflammation, controlling immune responses, and protecting kidney health.

1. Supportive Care and Lifestyle Adjustments

Adequate rest and maintaining body warmth are fundamental during acute phases. Patients should consume a balanced diet rich in calories and vitamins to support immune function and overall recovery. Staying well-hydrated and avoiding physical strain can also aid in faster healing.

2. Identifying and Eliminating Allergen Triggers

Since HSP is often linked to allergic or immune triggers, identifying potential allergens is critical. Common culprits include seafood such as fish and shellfish, certain food additives, and specific medications. Once suspected triggers are identified, they should be strictly avoided to prevent disease exacerbation.

3. Infection Prevention and Control

Infections—especially upper respiratory tract infections—can trigger or worsen HSP. Practicing good hygiene, staying up to date with vaccinations (where appropriate), and promptly treating any active infections help reduce the risk of flare-ups. Antibiotics may be used if a bacterial infection is confirmed.

4. Kidney Biopsy for Accurate Diagnosis

In cases where kidney involvement is suspected, a renal biopsy may be recommended when clinically feasible. This procedure allows physicians to assess the extent of glomerular damage, classify the severity of nephritis, and guide targeted therapy decisions based on histopathological findings.

5. Managing Isolated Hematuria

For patients presenting with isolated microscopic or mild gross hematuria without significant proteinuria, treatment is generally supportive. Hemostatic agents and symptomatic therapies may be used to manage bleeding, although close monitoring is essential to detect progression.

6. Treating Proteinuria: A Risk-Stratified Approach

The presence and level of proteinuria play a crucial role in determining treatment intensity. Patients whose protein excretion reaches nephrotic range (typically >3.5 g/day) usually require aggressive immunosuppressive therapy. This often includes corticosteroids combined with cytotoxic agents like cyclophosphamide to suppress abnormal immune activity and reduce kidney inflammation.

For those with non-nephrotic levels of proteinuria, a more conservative regimen is typically adopted. Low-dose steroid therapy may be sufficient, especially when combined with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs). These medications not only lower blood pressure but also significantly reduce protein leakage in the urine, offering renal protective benefits.

7. Antihistamine and Adjunctive Anti-Allergic Therapies

To address the underlying hypersensitivity component of HSP, antiallergic treatments are commonly employed. Medications such as chlorpheniramine, cetirizine, and loratadine help alleviate systemic allergic symptoms. Additionally, supplemental calcium, vitamin C, and troxerutin (a bioflavonoid with vascular-stabilizing properties) may support capillary integrity and reduce purpuric lesions.

Conclusion: Toward Individualized and Proactive Care

Treating Henoch-Schönlein purpura nephritis requires a multifaceted strategy that balances immunomodulation, renal protection, and lifestyle management. With timely intervention and ongoing monitoring, many patients experience favorable outcomes. Collaborative care involving nephrologists, allergists, and primary care providers enhances the likelihood of long-term remission and improved quality of life.