HSP typically presents with the triad of
Abdominal pain or arthralgia sometimes precede the rash.The commonest age group is 2 - 8 years. The cause is unknown but there may be a recent history of an upper respiratory tract infection.
Urine analysis should be performed, and if haematuria is present the sample should be sent for microscopy to quantify the RBC count.
Other investigations may include:
All patients presenting with a purpuric rash must be seen by a consultant or registrar, even if the child does not appear unwell.
use of prednisolone has not been shown to make clinically important
improvements in the rate of long-term renal complications. It has been
shown to reduce the duration of abdominal and joint pain and may reduce the risk of
abdominal complications. It may be considered for use in
patients with more than mild joint or abdominal pain. Consider prednisolone
1mg/kg while symptoms persist.
abdominal complication. Arrange early surgical consultation.
renal complication eg nephritis, nephrotic syndrome
Give the family a Parent Information Sheet on HSP
If discharged from the ED then it is imperative that appropriate follow-up is arranged to ensure adequate symptom control and resolution of the disease. Short term support can occur in the ED but follow-up care should soon be transferred to the GP (emphasise the need for ongoing BP and urine review in the letter) or a paediatrician - an appointment may be made in the General Medical Outpatient Clinic. The rash is usually the last manifestation to remit and appears to worsen if the child is very active. Some recommend an annual BP and urinalysis for life.
As the renal involvement can present up to six months after the initial presentation the urine should be checked regularly for that period. The blood pressure should be checked twice during that time. If the child has persistent renal involvement they should be referred to a paediatrician, or paediatric nephrologist for long term follow up.
Parent Information Sheet (Print version - PDF)
Parent Information Sheet (HTML version)
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