Which renal findings are characteristic of Henoch-Schönlein purpura (IgA vasculitis)?

Updated: Jan 08, 2021
  • Author: Rajendra Bhimma, MBChB, MD, PhD, DCH (SA), FCP(Paeds)(SA), MMed(Natal); Chief Editor: Craig B Langman, MD  more...
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The most serious complication of IgAV is kidney involvement, which occurs in 50% of older children but is serious in only approximately 10% of patients. In 80% of patients, kidney involvement becomes apparent within the first 4 weeks of illness. Overall, 2-5% of patients progress to end-stage kidney disease (ESKD).

In one series, acute glomerular lesions, including mesangial hypercellularity, endocapillary proliferation, necrosis, cellular crescents, and leukocyte infiltration, were observed in 41%, 12%, 50%, 29%, and 32% of patients, respectively. [81] Only glomerular necrotizing lesions and cellular crescents correlated with the renal survival rate and were associated with clinically significant proteinuria and development of hypertension.

In a prospective study of 223 children with IgAV, Jauhola et al reported that 46% developed renal manifestations. [82] The authors recommended that children with kidney involvement be followed for more than 6 months. In addition, they noted that treatment with prednisone did not affect the renal manifestations.

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