What is the role of corticosteroids in the management 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

Clinicians often use corticosteroids to treat subcutaneous edema and nephritis in IgAV, as well as to ameliorate associated arthralgias and symptoms associated with GI dysfunction. However, high-quality, large, prospective studies regarding the treatment of IgAV are lacking, [99, 100, 101] and the evidence does not yet support the use of steroids to prevent or treat kidney disease. [35, 102] Some authors recommend steroids; others do not. Nevertheless, corticosteroids may be considered in the following situations:

  • Persistent nephrotic syndrome
  • Crescents in more than 50% of glomeruli
  • Severe abdominal pain
  • Substantial GI hemorrhage
  • Severe soft tissue edema
  • Severe scrotal edema
  • Neurologic system involvement
  • Intrapulmonary hemorrhage

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