See also

Fever and petechiae 
The acutely swollen joint 
Hypertension 
Haematuria 
Intussusception

Key points

1. IgA vasculitis (IgAV) is usually mild and self-limiting, with most children requiring supportive care only
2. Acute severe abdominal pain requires urgent assessment for complications such as intussusception
3. Routine blood pressure and urinalysis monitoring for 12 months is required to detect delayed-onset IgA nephritis (IgAVN)

Background

IgAV, formerly known as Henoch-Schönlein purpura (HSP), is the most common childhood vasculitis

• immune complex-mediated, small vessel leukocytoclastic vasculitis with multi-organ involvement
• most common in primary-school aged children (4-10 years), and rare <2 years of age
• most cases are self-limiting and require supportive care only
• gastrointestinal or renal manifestations require early recognition and escalation - onset of renal manifestations may be delayed and requires monitoring for 12 months
• Recurrence is common (~1/3) within the first 6 months and is usually of milder severity

Assessment

IgAV is a clinical diagnosis

Clinical features include the presence of purpuric/petechial rash with a lower limb predominance AND one or more of the following

• Arthritis/arthralgia (60-80%)
• Abdominal pain (50-75%)
• Renal involvement (20-55%)

History

• Timing and evolution of symptoms: clinical manifestations may evolve over days to weeks and vary in order of appearance
  • Rash occurs in almost all cases, but up to 1/3 have other manifestations that can precede it by several days
• A preceding infection is common, particularly upper respiratory tract infections
• Colicky abdominal pain, vomiting, or gastrointestinal bleeding may indicate a significant gastrointestinal manifestation such as intussusception
• Arthralgia/ arthritis most commonly affects large lower-limb joints causing pain, limp or refusal to weight bear
• Haematuria, reduced urine output, or oedema
• Scrotal swelling or testicular pain (requires assessment to exclude testicular torsion)

Examination

Typical rash and distribution

This image has been reproduced with permission from Trnka P. Henoch-Schönlein purpura in children. J Paediatr Child Health. 2013;49(12):995-1003

Management

Investigations

There is no single diagnostic test for IgAV; diagnosis relies on clinical manifestations (and rarely histopathological findings)

All children with suspected IgAV should have:

• Height
• Weight
• Blood pressure
• Urinalysis (and if abnormalities include urine protein: creatinine ratio (UPCR) - ideally early morning urinalysis (EMU) should be performed

Children with moderate to severe IgAV (red flags and/or warranting admission and/or subspecialty consultation) should also have

• FBE, UEC, LFTs

Additional investigations are performed to assess for IgAV manifestations or differentials

• Blood film
• Coagulation profile
• Bacterial and/or viral cultures/PCRs (See Petechiae and purpura)
• ASOT and Anti-DNaseB
• CRP and ESR
• ANA, ENA, dsDNA, C3 and C4 and ANCA (including MPO and PR3 antibodies), in consultation with rheumatology

Treatment

Musculoskeletal manifestations

• Bed rest and/or reduced physical activity
• Elevation if oedema present
• Simple analgesia (if no contraindications)
  • Paracetamol
  • Ibuprofen, or Naproxen 7.5 mg/kg/dose (max 500 mg) oral bd
• Corticosteroids: consider in cases of severe or persistent pain

Gastrointestinal manifestations

Mild gastrointestinal pain or symptoms

• Support hydration and nutrition
• Simple analgesia (if no contraindications) and/or anti-emetics

Moderate to severe abdominal pain or gastrointestinal bleeding

• Admit for supportive measures and ongoing reassessment for evolving manifestations eg intussusception, bowel ischaemia or perforation, protein-losing enteropathy, pancreatitis, appendicitis or cholecystiti
• Surgical, radiology and/or gastroenterology consultations where appropriate
• Conisder corticosteroids: of most benefit if initiated within 3 days of onset of symptoms
  • Prednisolone: 1-2 mg/kg/day (max 60 mg) oral daily for 1-2 weeks OR 
  • Methylprednisolone: 1-2 mg/kg/day (max 60 mg) intravenous until able to tolerate and/or absorb via oral administration route

Urogenital manifestations

Orchitis

• Surgical consultation and exclusion of testicular torsion
• Simple analgesia
• Corticosteroids: consider prednisolone 1-2 mg/kg/day (max 60mg) oral daily for 1-2 weeks

Renal manifestations

• If there are concerns of nephritis consult nephrology
• Corticosteroids: not used for prophylaxis. No evidence prophylactic treatment prevents the development on IgAVN

Follow up

Review for new or ongoing renal manifestations

• Renal manifestations: ~90% of those who will develop renal disease present within 2 months, and ~97% within 6 months, so ongoing monitoring is essential
• Long-term kidney impairment is rare (<1–2%)
• Follow up can be with the child’s GP or paediatrician unless follow up with a subspecialty team (for IgAV or IgAVN) is required

Mild IgAV disease

• Mild symptoms and normal urinalysis or isolated microscopic haematuria or transient mild proteinuria
• Requires follow up with blood pressure and ideally EMU

If there is no IgAV recurrence and urinalysis is normal at 12 months, no further routine follow up is recommended

If there are new urine abnormalities and/or symptoms of IgAV recurrence

• repeat investigations
• subspecialty consultation recommended

Consider consultation with local paediatric team when

• Any red flag features
  • Severe pain
  • Inability to mobilise
  • Severe skin disease (haemorrhagic/ ulcerative/ necrotic skin lesions)
  • Gastrointestinal bleeding, peritonism, obstruction, severe dehydration/shock
  • Testicular scrotal pain/ swelling
  • Renal impairment, nephritic syndrome, nephrotic syndrome, Hypertension (≥Stage 2)
  • Neurological, cardiac, pulmonary, other rare manifestations
• Moderate pain
• Gastrointestinal dysfunction (eg ileus) or dehydration
• Persisting or recurrent IgAV disease

Consider consultation with a renal specialist

• Renal impairment: reduced eGFR <90 mL/min/1.73m² (calculated using CKiD U25 eGFR calculator)
• Nephritic syndrome
• Hypertension (≥Stage 2)
• Macroscopic haematuria
• Microscopic haematuria with proteinuria
• Nephrotic syndrome
• Nephrotic-range proteinuria: spot UPCR ≥200 mg/mmol; ≥2 mg/mg; ≥3+ or 4+ on urinalysis
• Proteinuria, using UPCR
  • Moderate: UPCR 100-200 mg/mmol or 1-2 mg/mg or 2+ on urine dipstick analysis for ≥2 weeks
  • Mild: UPCR 20-50 mg/mmol or 0.2-0.5 mg/mg or 1+ on urine dipstick analysis ≥4 weeks

Consider transfer when

care required for  child is beyond the comfort level of the health care service

For emergency advice and paediatric or neonatal ICU transfers, see Retrieval services

Consider discharge when

Discharge advice

• Most symptoms resolve within 4 weeks, and almost all children recover fully
• Rash (petechiae/purpura) usually settles over about 10 days and is often the last feature to resolve
• Joint symptoms are nondamaging and improve over days to a few weeks
• Uncomplicated abdominal pain usually improves within a few days but may recur intermittently for several weeks
• Renal involvement occurs in a minority of children and most children who develop kidney involvement do so by 6 months, so follow up urine testing is important
• Long-term kidney impairment is rare (<1-2%) and overall prognosis is excellent in most children
• Recurrence occurs in up to one third of children, usually within 6 months
• Parents should seek urgent medical review if their child develops severe abdominal, joint or skin pain, any scrotal pain, blood in urine or stool, reduced urine output, or any sudden deterioration

IgAV discharge follow up template
Victoria (Kids Health Info): Henoch-Schonlein purpura
Western Australia (PCH): Henoch-Schonlein purpura

Additional notes

Definitions

• Atypical IgAV rash: extensive +/- diffusely distributed lesions
• Persisting IgAV: the typical purpuric/ petechial rash persisting for >1 month
• Recurrent IgAV: reappearance of the typical purpuric/ petechial rash or other systemic manifestations of vasculitis following a symptom-free period of at least >1 month

Last updated August 2026

• The UK Kidney Association: The initial management of IgA Vasculitis (Henoch Schönlein purpura) in children and young people. 2022. Available: https://ukkidney.org/sites/renal.org/files/R2vFINAL_IgA%20vasculitis%20-%20initial%20management220523.pdf
• The UK Kidney Association: The management of complications associated with IgA Vasculitis (Henoch Schönlein purpura) in children and young people. 2022.Available: https://ukkidney.org/sites/renal.org/files/R1vFINAL_IgA%20vasculitis%20-%20complications220523.pdf
• Vivarelli M, Samuel S, Coppo R, Barratt J, Bonilla-Felix M, Haffner D et al. International Pediatric Nephrology Association. IPNA clinical practice recommendations for the diagnosis and management of children with IgA nephropathy and IgA vasculitis nephritis. Pediatr Nephrol. 2025;40(2):533-569
• Weiss P F, Feinstein J A, Luan X, Burnham J M, Feudtner C. Effects of corticosteroid on Henoch-Schönlein purpura: a systematic review. Pediatrics. 2007;120(5):1079-1087
• Zhao Q, Yang Y, He S W, Wang X T, Liu C. Risk factors for intussusception in children with Henoch-Schönlein purpura: A case-control study. World J Clin Cases. 2021;9(22):6244-6253