Henoch Schonlein purpura

Question 1

What is HSP?

Answer 1

IgA vasculitis - purpuric rash affecting lower limbs and buttocks

Question 2

What organs does HSP affect?

Answer 2

Skin
Kidneys
GI tract

Question 3

What often triggers HSP?

Answer 3

Upper AW infection
Gastroenteritis

Question 4

What age grouop is HSP most common in?

Answer 4

Under 10 yeras

Question 5

Four classic features of HSP

Answer 5

Purpura - 100)%
Joint pain - 75%
Abdo pain -
Renal involevemnt
Both 50%

Question 6

What are purpura like?

Answer 6

red purple
Palpable under skin

Question 7

Wjat joints are most affected in HSP?

Answer 7

Knees and ankles -> arthralgia or arthritis

Question 8

What happens in arthralgia/arthritis in HSP?

Answer 8

Joints become swollen and painful with reduced ROM

Question 9

What can severe cases of HSP lead to in GI innvolevemtn?

Answer 9

GI haemorrhage
Intussusception
Bowel infarction

Question 10

What does kidney involvement in HSP cause?

Answer 10

IgA/HSP nephritis

Question 11

What can HSP nephritis lead to?

Answer 11

Microscopic or macroscopic haematuria and proteinuria

Question 12

What shows that a child with HSP has deceloped nephrotic syndrome?

Answer 12

+2 protein on urine dipstick
Serum albumin

Question 13

Signs of nephrotic syndrome in children

Answer 13

Degree of oedema

Question 14

What is morst important step in diagnosis of HSP?

Answer 14

Rule out Meningococcal septicaemia Leukaemia
Idiopathic thrombocytopenia purpura
Haemolytic uraemic syndrome

Question 15

Investigations with HSP

Answer 15

FBC
Blood film
Serum albumin
Renal profile
CRP - sepsis
Blood cultures
Urine dipstick - proteinuria
Urine ACR - quantify proteniuria
BP - HPTN

Question 16

What test quantifies proteinuria?

Answer 16

ACR

Question 17

What do FBC and blood film screen for in HSP?

Answer 17

Thrombocytopenia
Sepsis
Leukaewmia

Question 18

Diagnosing HSP criteria

Answer 18

EULAR/PRINTO/PRES

Question 19

What does EULAR/PRINTO/PRES criteria require a child to have to have HSP?

Answer 19

Palpable purpura and at least one of:
Diffuse abdominal pain
Arthritis or arthralgia
IgA depositis on histology - biopsy
Proteinuria or haematuria

Question 20

What is management for HSP?

Answer 20

Supportive
Simple analgesia, rest, poor hydration
Use of steroids debatable (shorten but dont improve long erm outcomes)

Question 21

What monitor in patients with HSP?

Answer 21

Urine dipstick - renal involvement
BP - HPTN

Question 22

Prognosis HSP

Answer 22

Abdominal pain settles in days
Patients with kindey involved - 4-6 weeks
Small % develop end stage renal failure

Question 23

What % of patients have an occurence in 6 months?

Answer 23

1/3