what type of vasculitis is Henoch Schonlein purpura?
multisystem small vessel vasculitis
which organs does HSP affect?
skin, joints, GI, kidney
what is HSP also known as?
what age does HSP affect?
2-11 years old
is HSP more in boys or girls?
- boys (even though autoimmune!)
what is the cause of HSP?
- exact unknown
- immunopathological involvement
- increased IgA in serum
- make complexes, activate complement and deposited in affected organs
- precipitate an inflammatory response with vascultiis
which other disease does HSP have an overlap with?
what time of year is HSP more frequent in?
what are the trigger agents for HSP?
- infectious agents - URTI
- insect bites
what are the clinical features of HSP?
- purpuric rash - but initially urticarial. affecting predominantly extensors (buttocks, legs) symmetrical
- arthritis with pain and swelling - knees and ankles
- cramping abdominal pain, GI bleed - complication intussusception ileoileal
- renal: haematuria, proteinuria in a minority of patients. can be severe. clinical glomerulonephritis or nephrotic syndrome
differential diagnosis of HSP
- other cause of abdominal pain
- other causes of purpuric or petechial pain eg ITP
how is diagnosis of HSP made?
what are the useful Ix for HSP?
- FBC - normal platelet count rules out ITP
- renal funciton U&E
- US abdo - rule out intussecption
what is Rx of HSP?
- symptomatic and supportive
- paracetamol or NSAIDs control pain
- oral steroids occasional used if severe abdominal pain but ensure intussesception not present
what is prognosis of HSP
majority full recovery in 4-6 weeks
what does long term prognosis of HSP depend on?
presence and severity of NEPHRITIS
why do you have to follow up HSP for prolonged period?
to monitor renal function
what % of pts with HSP progress to end stage renal failure
only 1% pts progress to end stage renal disease