HSP

Question 1

Key points HSP

Answer 1

Urinalysis and blood pressure measurement must be done when Henoch-Schönlein purpura (HSP) is suspected
Most cases are self-limiting and only require symptomatic management
Close follow-up is critical to identify significant renal involvement requiring intervention. Renal involvement is usually asymptomatic

Question 2

EPID HSP

Answer 2

2-8YO

Question 3

FEATURES OF HSP

Answer 3

HSP is a clinical diagnosis
The features include rash, and one or more of:

Arthritis/arthralgia (50-75%)
Abdominal pain (50%)

Question 4

HSP Hx and exam

Answer 4

https://www.rch.org.au/clinicalguide/guideline_index/HenochSchonlein_purpura/

Question 5

red flags in HSP

Answer 5

Signs of bowel obstruction
Peritonism
Testicular pain
Respt distress
AMS
FND
Macroscopic hematuria
Severe proteinuria

Question 6

MC cx HSP

Answer 6

Intussusception

Question 7

https://www.rch.org.au/uploadedImages/Main/Content/clinicalguide/guideline_index/HSP.jpg

Answer 7

HSP

Question 8

IX for HSP

Answer 8

Urinalysis is usually the only investigation needed in a classic presentation of HSP
If there is hypertension, macroscopic haematuria or significant proteinuria, also perform:

Formal urine microscopy and urinary protein-creatinine ratio (UPCR)
UEC and albumin
Additional investigations may be required to rule out differentials if the diagnosis is unclear (eg ITP, leukaemia, meningococcal infection) or to identify potential complications of HSP:

FBE, UEC, albumin
Blood and urine cultures
Abdominal imaging
ASOT and anti-DNAse B
ANA, dsDNA, ANCA, C3, C4 if significant renal involvement with an unclear diagnosis

Question 9

TX HSP

Answer 9

https://www.rch.org.au/clinicalguide/guideline_index/HenochSchonlein_purpura/

Question 10

When to consider consultaiton with peadiatric team in HSP

Answer 10

Serious abdominal complications
Severe debilitating pain
Severe renal involvement (see UPCR values below)
Neurological or pulmonary involvement
If treatment with prednisolone is considered
The development of hypertension, proteinuria or macroscopic haematuria at any point should prompt a paediatric review and the investigations as outlined above

Consider consultation with a renal specialist when
Hypertension
Abnormal renal function
Macroscopic haematuria for 5 days
Nephrotic syndrome
Acute nephritic syndrome
Persistent proteinuria
UPCR >250 mg/mmol for 4 weeks
UPCR >100 mg/mmol for 3 months
UPCR >50 mg/mmol for 6 months