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Purpura
National Kidney and Urologic Diseases Information Clearinghouse
U.S. Department
of Health and The primary symptom of Henoch-Schönlein purpura is a
Human Services rash that looks like many small raised bruises on the legs.
What are the symptoms How is HSP diagnosed?
of HSP? When a typical rash, abdominal pain, and
HSP has four main symptoms: arthritis are present, the doctor can easily
recognize HSP. But many people with HSP
• Rashes and bruising. Leaking blood have only the rash, which can sometimes be
vessels in the skin cause rashes that seen as a symptom of other conditions and
look like bruises or small red dots to may delay the clinical diagnosis of HSP.
develop on the legs, buttocks, and
back of the arms. The rash may first The doctor may need to perform a series of
look like hives, then change to look tests to confirm a diagnosis of HSP, as no
like bruises. Rarely, the rash may single test for HSP exists.
spread to the upper part of the body, • Blood test. Elevated levels of blood
but it is usually on the parts of the urea nitrogen and creatinine, which
body that “hang down,” like the legs, are waste products that are normally in
buttocks, elbows, and even earlobes. the blood at low levels, indicate that
The rash does not disappear or turn the kidneys are affected. Healthy
pale when you press on it. kidneys filter urea and creatinine
• Abdominal pain. About two-thirds of from blood.
people with HSP experience pain in • Urine sample. A urine sample is
the stomach that may cause vomiting needed to check for hematuria, which
or blood in the stool. This pain and is blood in the urine, and to check for
bleeding can vary from mild to severe. proteinuria, which is protein in the
• Arthritis. About 80 percent of people urine. Blood and high levels of pro-
with HSP have pain and swelling in tein in the urine indicate damage to
their joints, usually in the knees and the kidneys.
ankles, less frequently in the elbows • Skin biopsy. If other testing is incon-
and wrists. These joint symptoms have clusive, and a diagnosis is required,
no long-lasting effects, although they the doctor may take a small sample of
can be very uncomfortable while your skin to examine with a micro-
they’re present. scope. The biopsy may reveal large
• Kidney involvement. Blood in the numbers of white blood cells in the
urine (hematuria) occurs in about 40 skin and deposits of IgA, one of the
percent of people with HSP. Often the proteins normally made by the immune
blood cannot be seen by the naked system to help fight off infections.
eye, but it can be measured with a • Kidney biopsy. When the kidneys
laboratory test called a urinalysis. In are affected by HSP, the nephrologist
most people the hematuria goes away (kidney specialist) may take a small
without permanent kidney damage. sample of kidney tissue to examine
Protein in the urine or development of with a microscope. Examining the
high blood pressure (hypertension) sample can help the doctor decide
suggests more severe kidney problems. what specific medicines, if any, need
to be given for the kidney disease.
Very few patients with HSP need a
kidney biopsy.
2 Henoch-Schönlein Purpura
Several diseases share some of the symp- What is the long-term
toms of HSP. But consistent physical exam
findings, along with blood, urine, and skin outlook?
test results taken together, can help the Most cases of HSP resolve within 4 to 6
doctor identify HSP. weeks without long-term problems. About
one in three people has a recurrence of
HSP. Recurrences usually occur within a
How is HSP treated? few months and are usually less severe than
There is no specific treatment for HSP. The the initial episode. When the symptoms
main goals of treatment are to relieve symp- recur or last longer than 6 weeks, they can
toms such as joint pain, abdominal pain, or be very frustrating and uncomfortable. The
swelling. In most cases, you can use over- long-term outlook is still good, however, as
the-counter medicines, such as acetamino- long as your kidneys are healthy.
phen (Tylenol), for the pain. In some
patients with severe arthritis, the doctor If you develop progressive kidney disease,
may prescribe prednisone, a steroid medi- you will need to have regular checkups to
cine. As mentioned earlier, the rash and monitor your kidney function. In the early
joint symptoms usually go away after 4 to 6 stages of kidney disease, you may not have
weeks without causing permanent damage. any symptoms, but blood and urine tests
may show that your kidney function is
Severe problems with the bowels are rare in declining. If you continue to have blood
HSP, especially in younger children. If you and protein in your urine, you are at greater
have severe pain or severe bleeding in the risk of developing chronic kidney disease.
digestive tract your doctor may prescribe
prednisone, or the problem may need to be Between 20 and 50 percent of children with
corrected with surgery. HSP develop some kidney problems, but
only 1 percent progress to total kidney fail-
Your doctor will check your kidney function ure. Progression to kidney failure may take
with blood and urine tests even after the as long as 10 years.
main symptoms of HSP disappear. People
who develop kidney disease usually show
signs within 3 to 6 months after the initial Hope Through Research
rash appears. If signs of kidney disease Through its Division of Kidney, Urologic,
appear, your doctor will refer you to a and Hematologic Diseases, the National
nephrologist, who may prescribe drugs to Institute of Diabetes and Digestive and
suppress the immune system. These Kidney Diseases (NIDDK) supports several
immunosuppressive drugs may keep kidney programs and studies devoted to improving
disease from progressing to permanent treatment for patients with progressive kid-
kidney failure. ney disease and kidney failure. The NID-
DK maintains the Pediatric Nephrology
Program, which supports research into the
The U.S. Government does not endorse or favor causes, treatment, and prevention of kidney
any specific commercial product or company. diseases in children, including congenital
Trade, proprietary, or company names appearing
in this document are used only because they are
malformations of the urinary tract, poly-
considered necessary in the context of the cystic disease, primary glomerular disease,
information provided. If a product is not and postinfectious glomerulonephritis.
mentioned, the omission does not mean or
imply that the product is unsatisfactory.
3 Henoch-Schönlein Purpura
For More Information National Kidney and
American Academy of Pediatrics Urologic Diseases
141 Northwest Point Boulevard Information Clearinghouse
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Email: kidsdocs@aap.org
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Internet: www.aap.org Fax: 703–738–4929
American Academy of Family Physicians Email: nkudic@info.niddk.nih.gov
Internet: www.kidney.niddk.nih.gov
P.O. Box 11210
Shawnee Mission, KS 66207–1210 The National Kidney and Urologic Diseases Infor-
Phone: 1–800–274–2237 mation Clearinghouse (NKUDIC) is a service of the
National Institute of Diabetes and Digestive and Kidney
Email: fp@aafp.org Diseases (NIDDK). The NIDDK is part of the National
Internet: www.familydoctor.org Institutes of Health under the U.S. Department of
Health and Human Services. Established in 1987, the
American Society of Pediatric Nephrology
Clearinghouse provides information about diseases of
Northwestern University the kidneys and urologic system to people with kidney
Feinberg School of Medicine and urologic disorders and to their families, health care
Pediatrics W140 professionals, and the public. The NKUDIC answers
303 East Chicago Avenue inquiries, develops and distributes publications, and
Chicago, IL 60611–3008 works closely with professional and patient organi-
Phone: 312–503–4000 zations and Government agencies to coordinate
Fax: 312–503–1181 resources about kidney and urologic diseases.
Email: aspn@northwestern.edu Publications produced by the Clearinghouse are care-
Internet: www.aspneph.com fully reviewed by both NIDDK scientists and outside
experts. The NKUDIC would like to thank Joseph
National Arthritis and Musculoskeletal Flynn, M.D., of the American Society of Pediatric
and Skin Diseases Information Nephrology (ASPN), for coordinating the review of this
Clearinghouse publication by the ASPN’s Clinical Affairs Committee:
National Institutes of Health Barbara Fivush, M.D. (co-chair), Steve Wassner, M.D.
(co-chair), John Brandt, M.D., Deepa Chand, M.D., Ira
1 AMS Circle
Davis, M.D., Stuart Goldstein, M.D., Ann Guillot, M.D.,
Bethesda, MD 20892–3675 Deborah Kees-Folts, M.D., Juan Kupferman, M.D.,
Phone: 1–877–22NIAMS (226–4267) Gary Lerner, M.D., Tej Mattoo, M.D., Alicia Neu, M.D.,
or 301–495–4484 Cynthia Pan, M.D., William Primack, M.D., and Michael
TTY: 301–565–2966 Somers, M.D.
Fax: 301–718–6366
Email: niamsinfo@mail.nih.gov
Internet: www.niams.nih.gov This publication is not copyrighted. The Clearing-
house encourages users of this fact sheet to dupli-
cate and distribute as many copies as desired.
This fact sheet is also available at
www.kidney.niddk.nih.gov.