Henoch-Schönlein Purpura Management Guidelines

Initial Assessment and Treatment

The American Journal of Kidney Diseases recommends measuring blood pressure and obtaining serum creatinine and BUN in adolescents with HSP, as they are at higher risk for severe renal involvement 1
The American Journal of Kidney Diseases suggests that adolescents with HSP have worse outcomes than younger children, with higher rates of severe renal involvement, persistent nephritis, and progression to end-stage renal disease (1-5% overall) 1
The American Journal of Kidney Diseases advises against using corticosteroids prophylactically at HSP onset, even in adolescents, as moderate-quality evidence shows they do not prevent renal involvement or decrease risk of severe persistent nephritis (Grade 1B recommendation) 1, 2

The American Journal of Kidney Diseases recommends performing renal biopsy if the patient presents with decreased renal function, severe nephrotic syndrome, or nephritic syndrome at initial presentation 1
The American Journal of Kidney Diseases suggests initiating ACE inhibitor or ARB for persistent significant proteinuria, targeting reduction to <1 g/day/1.73 m² 1, 2

The American Journal of Kidney Diseases recommends starting corticosteroid therapy only if nephrotic-range proteinuria persists after adequate trial of ACE inhibitor/ARB (8-12 weeks) 1, 2
The American Journal of Kidney Diseases advises administering high-dose intravenous methylprednisolone immediately for crescentic HSP with nephrotic syndrome and/or deteriorating kidney function 1, 2
The American Journal of Kidney Diseases suggests adding cyclophosphamide as the only immunosuppressive agent with RCT evidence for crescentic HSP nephritis in children 1, 2

The American Journal of Kidney Diseases warns against giving prophylactic corticosteroids at HSP onset to "prevent" nephritis, as this is ineffective and exposes patients to unnecessary steroid side effects 1, 2
The American Journal of Kidney Diseases advises against delaying renal biopsy in patients with decreased renal function at presentation, as crescentic disease requires immediate aggressive therapy 1