Paeds: HSP

Question 1

What is HSP?

Answer 1

An autoimmune vasculitis in children

IgA immune complexes get deposited in the small vessels of skin, joints, kidneys and GI tract

Question 2

What are the symptoms of HSP?

Answer 2

Purpura
Abdo pain
Nephritis (renal involvement in around 40%, microscopic haematuria with proteinuria, may develop nephrotic syndrome with oedema)
GI bleeding (bloody diarrhoea)
Scrotal swelling/pain

Tends to occur following a viral illness. Most commonly in Autumn and winter

Question 3

What is the age group for HSP?

Answer 3

90% are under 10

Peak age is 4-6

Question 4

Describe the rash of HSP

Answer 4

Symmetrical
Legs, buttocks, ulnar side of the arms
Initially erythematous macules
Within 24 hours progresses to purpura which may convalesce and appear like large bruises
The purpura are typicaly raised and palpable

Question 5

Renal complications of HSP

Answer 5

Can progress to ESRF

This occurs in <1%

Question 6

Workup for HSP patient

Answer 6

Urine - for blood and protein

U&E
FBC - exclude thrombocytopenia
ESR

Question 7

Treatment of HSP

Answer 7

Self-limiting illness
Rehydration, analgesia and treatment of complications such as bowel obstruction

No benefit shown from steroids, cyclophosphamide etc

Question 8

Follow-up

Answer 8

For those with no proteinuria: early monitoring of BP

For those with proteinuria they will need regular urinalysis and BP checks +/- renal fn

Question 9

Prognosis of HSP

Answer 9

Self-limiting. Most make full recovery

Around one third will get a recurrance in the first 6 months

<1% ESRF

CKD can develop, sometimes as much as 10 years later