Henoch-Schönlein Purpura (IgA Vasculitis) in Children: A Case-Based Guide to Diagnosis, Treatment and Renal Follow-Up
Henoch-Schönlein purpura (HSP), now called IgA vasculitis, is the most common childhood vasculitis, and its outcome depends largely on how well clinicians watch the kidneys. This case-based guide walks through the classic tetrad, the immune mechanism, diagnostic criteria, evidence-based treatment, and the complications that cannot be missed.
Why a Case-Based Approach to HSP Works
Henoch-Schönlein purpura looks simple on the surface: a child, a rash, some tummy ache and sore knees. Yet the decisions that follow are anything but simple. Should you image the abdomen? Start steroids? Biopsy the kidney? How long should you keep checking urine?
This article is built on a 14-cases. Each case ends with a clear answer and a rationale. Together they cover five domains:
- Clinical presentation – the classic tetrad
- Pathophysiology – galactose-deficient IgA1 and complement
- Diagnosis – classification criteria and investigations
- Treatment – from symptom relief to pulse therapy
- Complications – intussusception and long-term kidney outcomes
Clinical Presentation: Recognising the Classic Tetrad
The opening case
A 6-year-old boy arrives with a 3-day history of painful red-purple spots on his legs and buttocks. The rash is non-blanching and palpable. He also has severe knee pain and abdominal discomfort.
The options:
- idiopathic thrombocytopenic purpura
- Kawasaki disease
- Henoch-Schönlein purpura
- scarlet fever.
The answer is HSP, because the picture fits a well-defined tetrad.
Component Typical findings 1. Palpable purpura Dependent areas: legs and buttocks; symmetric and non-blanching 2. Arthralgia…
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