Henoch-Schonlein Purpura

Question 1

What is Henoch-Schonlein Purpura (HSP)?

Answer 1

It is defined as an IgA mediated small vessel vasculitis, in which there is deposition of IgA is deposited in vessel walls – leading to inflammation

Question 2

Which three regions of the body tend to be affected by Henoch-Schonlein purpura?

Answer 2

Skin

Kidneys

Gastrointestinal Tract

Question 3

What four risk factors are assoicated with Henoch-Schonlein purpura?

Answer 3

Children, 4 – 6 Years Old

Male Gender

Upper Respiratory Tract Infection

Gastroenteritis

Question 4

What are the eight clinical features of Henoch-Schonlein purpura?

Answer 4

Prodromal Coryzal Features

Low Grade Fever

Purpuric/Petechial Rash

Peripheral Oedema

Abdominal Pain

Polyarthritis

Frothy Urine

Haematuria

Question 5

Why is a rash associated with Henoch-Schonlein purpura?

Answer 5

It is due to inflammation and leaking of blood from small blood vessels under the skin

Question 6

Describe the rash associated with Henoch-Schonlein purpura

Answer 6

It is present on the buttocks and extensor surfaces of arms/legs

Question 7

What are petechiae?

Answer 7

It is defined as a non-blanching pinot spots < 3mm in diameter

Question 8

What are purpura?

Answer 8

It is defined as a non-blanching pinot spots > 3mm in diameter, commonly palpable

Question 9

Describe the arthralgia assoicated with Henoch-Schonlein purpura

Answer 9

It tends to present with pain the hip, knee and ankle joints

Question 10

What three investigations are used to diagnose Henoch-Schonlein purpura?

Answer 10

Blood Tests

Urinalysis

Renal Biopsy

Question 11

How are blood tests used to investigate Henoch-Schonlein purpura?

Answer 11

They are used to exclude differential diagnoses, and assess for organ involvement

Question 12

What eight blood tests are used to investigate Henoch-Schonlein purpura?

Answer 12

Full Blood Count

Liver Function Tests

Urea & Electrolytes

Serum Albumin

Serum CRP

Clotting Studies

Blood Film

Blood Cultures

Question 13

How is urinalysis used to investigate Henoch-Schonlein purpura?

Answer 13

It is used to exclude differential diagnoses, and assess for renal involvement

Question 14

What are the three features of Henoch-Schonlein purpura on urinalysis?

Answer 14

Haematuria

Proteinuria

Increased Protein : Creatinine

Question 15

When are renal biopsies used to investigate Henoch-Schonlein purpura?

Answer 15

When there is ongoing significant proteinuria or impaired renal function

Question 16

What is the feature of Henoch-Schonlein purpura on renal biopsies?

Answer 16

The presence of the IgA deposits within blood vessel walls

Question 17

What is the diagnostic criteria of Henoch-Schonlein purpura?

Answer 17

A diagnosis is obtained when individuals present with palpable purpura and one of the following criteria…

• Diffuse Abdominal Pain
• Polyarthralgia
• Proteinuria/Haematuria
• Positive Histopathology

Question 18

What is the first line management option of Henoch-Schonlein purpura?

Answer 18

Conservative Management

Question 19

What is the conservative management option of Henoch-Schonlein purpura?

Answer 19

It involves supportive management with rest, simple analgesia and hydration

In addition, we advise individuals that it is a self-limiting condition which usually resolves within a period of weeks to months

Question 20

What is the pharmacological management option of Henoch-Schonlein purpura?

Answer 20

Corticosteroids

Question 21

When are corticosteroids used to manage Henoch-Schonlein purpura?

Answer 21

When there is severe gastrointestinal pain or renal impairment

Question 22

How are corticosteroids used to manage Henoch-Schonlein purpura?

Answer 22

It is used to shorten the duration of illness; however, it is important to note that it doesn’t affect long term outcomes or recurrence rates

Question 23

Why are follow up appointments important in Henoch-Schonlein purpura?

Answer 23

This is due to the fact that renal involvement may not manifest until weeks later

Question 24

What follow up review is requried to manage Henoch-Schonlein purpura?

Answer 24

We conduct urine dipstick and blood pressure readings regularly for a period of six months after diagnosis

In cases where children present with renal involvement features, they must be re-reviewed in secondary care

However, children can be fully discharged if they have two consecutive normal urine dips and a normal blood pressure at six months

Question 25

What are the two complications associated with Henoch-Schonlein purpura?

Answer 25

Henoch-Schonlein Purpura Relapse

Renal Failure