HSP nephritis

also seeHenoch Schonlein Purpura,  Nephrotic Syndrome

• All children who have HSP experience diffuse vasculitis that even affects the renal vasculature.
• Urinalysis and serum electrolyte measurements should be obtained in all children who have suspected or proven HSP.
• RBCs are present in at least 50% of affected children, and occasionally gross hematuria is observed.
• The presence of proteinuria in any child who has HSP indicates pronounced renal injury.
• Poor prognostic signs include persistent diminished renal function (elevated serum creatinine), continual proteinuria, and hypertension requiring medical therapy.
• who have severe HSPN often develop chronic renal insufficiency.
• Treatment of HSPN with steroids has met with disappointing results, as has therapy with cyclophosphamide. However, recent studies suggest that combination treatment for HSPN with steroids and azathioprine may improve the prognosis in some patients.

Regardless of etiology, the initial management for patients who have NS includes steroid therapy. The duration of treatment may vary, and the child's response to steroids (as assessed by resolution of edema and proteinuria) ultimately suggests the possible cause of NS. A positive response to steroids usually predicts a milder form of NS (eg, MCNS); a muted response may indicate a more severe form (eg, FSGS). MCNS generally is a benign disease that does not result in any impairment of renal function and eventually resolves spontaneously.

References:
Julian BA, Quiggins PA, Thompson JS, Woodford SY, Gleason K, Wyatt RJ.
Familial IgA nephropathy. Evidence of an inherited mechanism of
disease. N Engl J Med. 1985;312:202-208
Meadow SR, Glasgow EF, White RH, Moncrieff MW, Cameron JS, Ogg CS.
Schonlein-Henoch nephritis. Q J Med. 1972;41:241-258
Nephrotic syndrome in children: prediction of histopathology from
clinical and laboratory characteristics at time of diagnosis. A report
of the International Study of Kidney Disease in Children. Kidney Int.
1978;13:159-165