Will Henoch-Schönlein Purpura Nephritis Come Back After Recovery?
Henoch-Schönlein purpura nephritis (HSPN) is a type of immune-mediated kidney disease that can develop following systemic vasculitis. While many patients achieve clinical remission with proper treatment, a critical question remains: can the condition return even after successful therapy? The answer is yes—although the majority of patients recover well, a small but notable percentage may experience a relapse.
Understanding Clinical Remission vs. Complete Cure
When discussing recovery from HSPN, it's important to distinguish between clinical remission and a complete biological cure. Most patients are considered "clinically cured" when symptoms disappear and laboratory tests—such as urine analysis, serum creatinine, and proteinuria levels—return to normal. This positive outcome is typically achieved through treatments involving corticosteroids and immunosuppressive agents, which help control inflammation and prevent further kidney damage.
What Happens in the Kidneys During HSPN?
Under a microscope, HSPN usually presents as mesangial proliferative glomerulonephritis, characterized by immune complex deposits in the glomeruli—the filtering units of the kidneys. Even after symptoms resolve, subtle inflammatory activity may persist at the tissue level. This subclinical inflammation doesn't always show up in blood or urine tests but can serve as a foundation for future flare-ups if triggered.
Triggers That May Lead to Relapse
Even in cases of apparent recovery, certain factors can reactivate kidney inflammation. Common triggers include:
- Infections – particularly upper respiratory tract infections, which are known to stimulate abnormal immune responses.
- Physical stress or overexertion – excessive fatigue or intense physical activity may compromise immune regulation.
- Environmental allergens or toxins – exposure to certain chemicals or allergens might reignite immune system activity.
These stressors can prompt the immune system to mistakenly attack the kidneys again, leading to a recurrence of proteinuria, hematuria, or even impaired kidney function.
How to Reduce the Risk of Recurrence
Long-term management plays a crucial role in preventing relapse. Patients who have recovered should maintain regular follow-ups with a nephrologist, monitor their urine and blood pressure, and adopt a kidney-friendly lifestyle. This includes staying hydrated, avoiding unnecessary medications (like NSAIDs), eating a balanced diet low in salt, and managing infections promptly.
In conclusion, while many individuals fully recover from Henoch-Schönlein purpura nephritis and lead normal lives, the possibility of relapse exists due to residual immune activity and external triggers. Ongoing vigilance and preventive care significantly improve long-term outcomes and help protect kidney health over time.