P200 Management of henoch schonlein purpura (HSP)

• Published in: Archives of disease in childhood Vol. 104; no. Suppl 3; p. A238
• Main Authors: Mahmood, Lubna, Zulfiqar, Farah, Khalid, Saira, Dillon, Michelle
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.06.2019
• Subjects: Analgesia; Arthralgia; Arthritis; Biopsy; Blood coagulation; Blood tests; Children; Childrens health; Diagnosis; End-stage renal disease; Guidelines; Hematuria; Immunoglobulin A; Kidney diseases; Management; Nephritis; Nephrotic syndrome; Pain perception; Patients; Pediatrics; Pharynx; Proteinuria; Renal failure; Renal function; Schonlein-Henoch purpura; Urinalysis; Urine; Vasculitis
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2019-epa.555

IntroductionHSP is a common vasculitis of childhood. It is immune mediated. Aetiology is unknown but the history often identifies a preceding throat/URTI infection.Agreed criteria for HSP diagnosis are:Palpable purpura (mandatory) in the presence of atleast one of the following;Diffuse abdominal painAcute arthritis or arthralgiaRenal involvement (haematuria +/_ proteinuria) Renal biopsy showing predominantly IgA deposition.Diagnosis is usually on clinical grounds . Bloods are needed to rule out other diagnoses. All patients need BP , urine dipstick, weight and height measurements.General supportive measures and simple analgesia is all that is required . HSP is usually self limiting. 33% will have relapses/recurrence of symptoms. HSP accounts for 3% of all patients with end-stage renal failure .AimTo look at management of HSP in our unit during the last six months, develop local guidelines and then re audit to monitor compliance with guidelines.MethodWe carried out a retrospective observational charts review of all children presenting with HSP .ResultsNo standard guidelines were being followed. Followup practices differed between teams. We developed local guidelines for the management of HSP.If the initial urinalysis is normal or only reveals microscopic haematuria , follow up involves : clinical review, BP measurement and early morning urinalysis at these recommended time intervals :Weekly for the first monthFortnightly from weeks 5 to 12Single review at 6 and 12 monthsReturn to (1) if there is disease flare upReferral to Paediatric Nephrologist is warranted if there is :Macroscopic haematuria more than 5 days.Persistent microscopic haematuria beyond 12 months.Persistent proteinuria.HypertensionAbnormal renal functionNephrotic syndromeNephritic syndromeWe carried out retrospective charts review again in the following six months . There were 7 cases of HSP noted . 5 patients had HSP with no renal involvement and were followed according to local protocol. It was noted that three of these patients had unnecessary blood tests done including Coagulation profile. One patient was not followed up after after the initial presentation due to miscommunication but later reviewed at 3 months.One patient has mild HSP Nephritis with persistent proteinurea and macroscopic haematuria and was referred to the nephrologist. Her symptoms resolved completely.We will continue to audit our practise. In addition to monitoring renal status we also aim to avoid unnecessary blood tests. Streaming our followup may identify early markers of renal disease in this group of children.