What is included in supportive management 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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Answer

Treatment of IgAV is primarily supportive and includes ensuring adequate hydration and monitoring for abdominal and kidney complications. For minor complaints of arthritis, edema, fever or malaise, symptomatic treatment is advised, including use of acetaminophen, elevation of swollen extremities, eating a bland diet, and adequate hydration. All unnecessary drugs should be discontinued if a drug-related etiology is suspected.

Most patients with self-limited cases can be safely discharged home with close follow-up by the primary physician. The decision for or against hospital admission depends on the physician’s customary practice and individual preference. Admission to the hospital is recommended for control of abdominal pain or vomiting, monitoring of kidney function, confirmation of a doubted diagnosis, and observation and monitoring. Patients with kidney involvement require close attention to their fluid balance, electrolyte status, and use of antihypertensives (if indicated).

A study examining prevention and treatment of kidney disease in patients with IgAV revealed no significant difference in the risk of persistent kidney disease at 6 months and 12 months in children given prednisone for 14-28 days upon presentation in comparison with placebo or supportive treatment. [99] Also, no significant difference was noted in the risk of persistent kidney disease in children given cyclophosphamide compared with supportive treatment and with cyclosporine compared with methylprednisolone.


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