Treatment Options for Henoch-Schönlein Purpura-Induced Nephritis

Henoch-Schönlein purpura (HSP), a form of systemic vasculitis, can lead to serious kidney complications known as HSP nephritis. This condition occurs when immune complexes deposit in the small blood vessels of the kidneys, triggering inflammation and potential long-term damage. The treatment approach varies significantly based on patient age, clinical presentation, and the severity of proteinuria.

Understanding Disease Severity and Patient Factors

The management of HSP nephritis is highly individualized. In pediatric patients, the disease often follows a self-limiting course, especially when symptoms are mild. Many children recover spontaneously without requiring aggressive intervention. However, close monitoring of renal function and urine analysis is essential to detect any progression early.

When Is Medical Intervention Necessary?

For patients—particularly those with persistent or heavy proteinuria—defined as more than 1 gram per day—or those presenting with full-blown nephrotic syndrome, treatment becomes critical. In such cases, corticosteroid therapy is typically initiated. Oral glucocorticoids like prednisone are commonly prescribed to reduce inflammation and suppress abnormal immune activity in the kidneys.

Advanced Therapies for Severe Cases

In more severe histological forms of HSP nephritis, especially when kidney biopsies reveal extensive crescent formation—a sign of rapidly progressive glomerulonephritis—intensive treatment is warranted. High-dose intravenous methylprednisolone pulses (0.5 to 1 gram per day) are administered over three consecutive days. This pulse therapy helps halt acute inflammatory processes and preserve kidney function.

If the initial course does not achieve sufficient response, a second round of methylprednisolone pulses may be considered. After the IV phase, patients are transitioned to oral steroid regimens, gradually tapered over several weeks to minimize side effects.

Combination Therapy with Immunosuppressants

For refractory or high-risk cases, additional immunosuppressive agents are often added to enhance therapeutic outcomes. Drugs such as cyclophosphamide or cyclosporine play a crucial role in modulating the immune system and preventing further renal damage. These medications are particularly beneficial in adults, who tend to have a less favorable prognosis compared to children.

Cyclophosphamide is often used in aggressive forms due to its potent immunosuppressive properties, while cyclosporine may be preferred in cases involving significant proteinuria and active inflammation, thanks to its targeted effect on T-cell activity.

Long-Term Monitoring and Prognosis

Regardless of the treatment path, ongoing follow-up is vital. Regular assessment of blood pressure, serum creatinine levels, and urinary protein excretion helps track recovery and detect relapses. Some patients may experience chronic kidney issues, emphasizing the need for sustained care.

With timely diagnosis and appropriate therapy, many individuals—especially younger patients—achieve remission and maintain good renal function. However, early intervention remains key to improving long-term outcomes and reducing the risk of end-stage kidney disease.