Prognosis of HSP

In the majority of children, the outcome of HSP is

excellent with spontaneous resolution of symptoms
and signs. HSP recurs in approximately one third of
patients, typically within 4 months of the initial
presentation. Recurrent purpura can be occasionally
associated with joint complaints and episodes of
gross haematuria although each subsequent episode
is generally milder and shorter. The long-term
morbidity of HSP is related to the degree of HSP
nephritis.

In unselected cohorts of children, HSP nephritis is a

mild disease, characterised by microscopic
haematuria and minimal proteinuria, with <1% risk of
progression to end-stage kidney disease (ESKD).[18]
Reports from tertiary centres indicating that 1030%
of children will develop ESKD are likely to
overestimate the true risk of ESKD due to the
selection of cases with more severe renal impairment
seen in these centres.[48, 49] Children at risk are
those with nephrotic or nephritic/nephrotic syndrome
or renal failure at presentation, and those with
impaired kidney function and persistent proteinuria
after several years of follow-up.[29] Children with
uncomplicated HSP are usually managed in the
primary care setting either by a GP or a paediatrician.
The aim of the initial follow-up is to identify patients
with worsening kidney involvement and is based on
serial urinalyses, blood pressure measurement, blood
tests to assess kidney function and exclusion of other
causes of glomerulonephritis. A practical pathway for
detection and referral of children with HSP nephritis
to a paediatric nephrologist during the first 612
months after diagnosis has been developed (Fig.7).
[50] The involvement of a paediatric rheumatologist in
cases of severe arthritis/arthralgia might also be
warranted.