What are potential complications of Henoch-Schönlein purpura (IgA vasculitis)?

Updated: Oct 28, 2020
  • Author: Rajendra Bhimma, MBChB, MD, PhD, DCH (SA), FCP(Paeds)(SA), MMed(Natal); Chief Editor: Craig B Langman, MD  more...
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Answer

Hematuria, usually microscopic, can be accompanied by mild-to-moderate proteinuria (< 2 g/day). Oliguria, hypertension, and azotemia are rarely present. Nephrotic syndrome (urinary protein excretion > 40 mg/m2/hr or protein:creatinine ratio ≥200 mg/mmol in an early morning spot urine) can also occur. In most cases, histologic examination of the kidneys reveals mesangial proliferation that can be diffuse or focal and segmental. Resolution of the kidney involvement is the focus in these patients.

A study reported that even patients with mild forms of IgAV nephritis are at risk for significant long-term proteinuria. The study also added that very early introduction of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers may improve the long-term outcome independent of histological lesions. [87]

GI complications include hydrops of the gallbladder, pancreatitis, and GI bleeding. Surgical complications include intussusception, bowel infarction, and perforation.

Overall, 5% of patients develop ESKD. Urinary complications include bladder-wall hematoma, calcified ureter, hydronephrosis, and urethritis.

In a retrospective Korean study of 212 children with IgAV, Lee et al found palpable purpura spots 98.1% of subjects, GI symptoms in 75.0%, joint symptoms in 69.8%, renal involvement in 26.9%, and nephrotic syndrome in 4.7%. The study also found that patients with severe GI symptoms and children over age 7 years had a significantly greater incidence of kidney involvement and nephrotic syndrome. [88]


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