Henoch Schonlein purpura Flashcards
What is HSP?
IgA vasculitis - purpuric rash affecting lower limbs and buttocks
What organs does HSP affect?
Skin
Kidneys
GI tract
What often triggers HSP?
Upper AW infection
Gastroenteritis
What age grouop is HSP most common in?
Under 10 yeras
Four classic features of HSP
Purpura - 100)%
Joint pain - 75%
Abdo pain -
Renal involevemnt
Both 50%
What are purpura like?
red purple
Palpable under skin
Wjat joints are most affected in HSP?
Knees and ankles -> arthralgia or arthritis
What happens in arthralgia/arthritis in HSP?
Joints become swollen and painful with reduced ROM
What can severe cases of HSP lead to in GI innvolevemtn?
GI haemorrhage
Intussusception
Bowel infarction
What does kidney involvement in HSP cause?
IgA/HSP nephritis
What can HSP nephritis lead to?
Microscopic or macroscopic haematuria and proteinuria
What shows that a child with HSP has deceloped nephrotic syndrome?
+2 protein on urine dipstick
Serum albumin
Signs of nephrotic syndrome in children
Degree of oedema
What is morst important step in diagnosis of HSP?
Rule out Meningococcal septicaemia Leukaemia
Idiopathic thrombocytopenia purpura
Haemolytic uraemic syndrome
Investigations with HSP
FBC
Blood film
Serum albumin
Renal profile
CRP - sepsis
Blood cultures
Urine dipstick - proteinuria
Urine ACR - quantify proteniuria
BP - HPTN
What test quantifies proteinuria?
ACR
What do FBC and blood film screen for in HSP?
Thrombocytopenia
Sepsis
Leukaewmia
Diagnosing HSP criteria
EULAR/PRINTO/PRES
What does EULAR/PRINTO/PRES criteria require a child to have to have HSP?
Palpable purpura and at least one of:
Diffuse abdominal pain
Arthritis or arthralgia
IgA depositis on histology - biopsy
Proteinuria or haematuria
What is management for HSP?
Supportive
Simple analgesia, rest, poor hydration
Use of steroids debatable (shorten but dont improve long erm outcomes)
What monitor in patients with HSP?
Urine dipstick - renal involvement
BP - HPTN
Prognosis HSP
Abdominal pain settles in days
Patients with kindey involved - 4-6 weeks
Small % develop end stage renal failure
What % of patients have an occurence in 6 months?
1/3
