HSP

Question 1

What is HSP?

Answer 1

Small vessel vasculitis ( most common vasculitis of childhood)

Question 2

Peak age of HSP

Answer 2

2-8yo

Question 3

Common triggers of HSP

Answer 3

• ~50% cases have Hx recent URTI

- Others - vax, meds, cold, bites

Question 4

Natural history of HSP

Answer 4

• Most self-limiting
• Clinical features take weeks to develop
• resolution in 4 weeks (rash last, but arthralgia/abdo pain only few days)
• Most renal complications occur within 2-6 months
• 25-35% cases recur within 4 months - subsequent episodes usually lighter and quicker

Question 5

Clinical features of HSP

Answer 5

• Arthritis/arthralgia (50-75%), often of lower joints
• Abdo pain (50%), signs of peritonism
• Renal involvement (25-50%): haematuria/proteinuria/hypertension
• Purpura: gravity dependent - lower limbs and buttocks
• Swelling: feet, hands, scrotum
• Respiratory distress
• Neuro: change in mental status/focal signs
• Blood in stool/haematuria

Question 6

Complications of HSP

Answer 6

• Renal
• Most common complication is intussussception
• Others – GI haemorrhage, bowel ischaemia, necrosis or perforation, protein-losing enteropathy and pancreatitis

Question 7

Investigations for HSP

Answer 7

• If classic HSP, only urinalysis needed
• If there is hypertension, macroscopic haematuria or significant proteinuria, send urine for formal microscopy and protein-creatinine ratio , and bloods for UEC and albumin
• AXR for intussusception

Question 8

Management of HSP

Answer 8

• Oedema: bed rest + elevation
• Pain:
  • Mild pain: reg paracetamol +/- NSAIDs (careful with renal impairment)
  • Steroids for mod-severe arthralgia/abdo pain

Question 9

What is important following resolution of HSP?

Answer 9

• Close F/U needed to identify renal involvement (remember, can be asymptomatic for a long time)
  • Weekly for the first month after disease onset

If there is no significant renal involvement plus normal urinalysis at 12 months, no further follow-up is required