What is it?

        Henoch-Schonlein purpura (HSP) is an illness where the blood vessels in the body are inflamed. Most often involved organs are skin, joints, intestines and the kidneys. Biopsy of the involved skin or kidneys show inflammation of the blood vessels and deposition of a protein called IgA.  Therefore, when only the kidneys are involved, it is also called IgA-Nephropathy.

    What causes it?

        The cause of HSP is unknown.  Occasionally HSP might be precipitated by the following:

            Infections:     Bacterial: (salmonella, clostridium, morgenella,
                                                 tuberculosis, streptococcus)
                                Viral:         mostly upper-respiratory infections
                                Parasitic:   amebiasis, toxocara

            Medications:     Vancomycin, Zantac, Vasotec, Captopril

            Other:         Cancers, Food allergies, exposure to cold

    Who gets it?

        Any one can be affected.
        But most of the time it afflicts children younger than 10 yr. of age.
        Males are affected at 2:1 ratio over females.
        Less common in those of African descent.
        Susceptibility to HSP may have a genetic origin.(Deletion of C4 genes)

   Symptoms:

        1. Skin rash             2.  Abdominal pain
        3. Joint pains          4.  Blood in the urine (Hematuria)
        5. Black bowel movement (indicating intestinal bleeding)
        6. Proteinuria

    Natural course of the disease:

        Usually self limited and lasts for a month.
Long protracted course is less common.
Kidney failure (Chronic renal failure) requiring dialysis is rare.
If HSP is associated with more than 1000 mgs of
   protein in the urine, then the possibility of gradually
   loosing kidney function (Chronic renal failure) is about
           18% in children and 28% in adults.
        Therefore, if protein in the urine (Proteinuria) persists then, the
            proteinuria needs to be treated (Ref: Treatment of proteinuria)

   Treatment:

        skin rash, if severe, may need symptomatic treatment
            with steroids.

        Abdominal pain may be relieved by pain medications
            and steroids.  On occasion, surgery may be needed
            to deal with abdominal complications.

        Treatment of the kidney disease in HSP is controversial
            and are often based on results from studies with small
            number of patients.
            The following are the some of the medications which
                    have been used with variable rate of success:
                            Prednisone             Methylprednisolone             Imuran
                            Cytoxan             Persantine             Intravenous Immunoglobulins

Most of the time observation and symptomatic
            treatment are all that are needed.