From the Guidelines
After Henoch-Schönlein Purpura (HSP), the primary precautions should focus on monitoring kidney function, managing symptoms, and preventing long-term complications, particularly in patients with persistent proteinuria, for whom treatment with ACEi or ARBs may be suggested, as indicated by the KDIGO practice guideline 1. The precautions involve several key aspects:
- Monitoring kidney function through regular urine tests for at least 6 months to check for blood or protein, which could indicate kidney involvement.
- Blood pressure monitoring is essential as hypertension can develop, and managing it is crucial for preventing further kidney damage.
- Follow-up appointments with a healthcare provider are necessary to track recovery and detect complications early, allowing for timely intervention.
- Adequate hydration and a balanced diet help support healing and overall health.
- Pain management is critical, and acetaminophen can be used (10-15 mg/kg every 4-6 hours, not exceeding 75 mg/kg/day or 4000 mg/day in adults), while avoiding NSAIDs like ibuprofen, which may worsen kidney issues, as suggested by clinical guidelines 1.
- Rest is important during active symptoms, with a gradual return to normal activities as symptoms improve, to prevent overexertion and potential worsening of the condition.
- Parents of affected children should watch for recurring rash, joint pain, abdominal pain, or changes in urination, which could indicate a flare-up or complication of HSP.
- Long-term follow-up is particularly important for patients who had kidney involvement, as they have a higher risk of developing chronic kidney disease, emphasizing the need for ongoing monitoring and management, in line with recommendations from studies like the KDIGO practice guideline 1.
From the Research
Precautions after Henoch-Schönlein Purpura (HSP)
- Patients with HSP should be monitored for prolonged periods to prevent long-term morbidity, particularly renal disease 2, 3, 4
- Regular urine testing for proteinuria and haematuria, as well as blood pressure measurement, should be performed for at least 6 months after diagnosis 3, 4
- Patients with severe renal involvement may require early aggressive therapy with high-dose steroids plus immunosuppressants 5, 2, 6
- Women with a history of HSP during childhood are at increased risk of complications during pregnancy and should be monitored closely 4
- A standardized pathway for monitoring HSP, such as the Alder Hey Henoch Schonlein Purpura Pathway, can help identify patients at higher risk of developing nephritis and prioritize their care 3
Management of HSP
- Supportive treatment is the primary intervention for most patients with HSP, as the condition spontaneously resolves in 94% of children and 89% of adults 2
- Oral prednisone at 1 to 2 mg per kg daily for two weeks can be used to treat abdominal and joint symptoms 2
- Plasma exchange in combination with low-dose oral cyclophosphamide and high-dose steroids may be effective in treating severe cases of HSP with multiorgan failure 6