Just a rash, or a warning sign of kidney failure? Vascular purpura, also called Henoch Schonlein purpura, can range from a mild, self-limited condition to a serious illness of the kidney or intestines. It can occur at any age, but usually affects children. The name comes from the characteristic rash, which is shown in the photos provided in the References. It is the most common form of vasculitis, which is inflammation of the blood vessels, in children.
The typical patient is a child who has just gotten over a respiratory infection. Most, but not all, cases include these four symptoms:
1. Purpura rash.
2. Arthritis pain in the joints.
3. Abdominal pain, sometimes with gastrointestinal bleeding.
4. Kidney inflammation, often with protein or blood in the urine.
Medical researchers do not understand why the inflammation of blood vessels occurs, although many cases begin shortly after an infection. There is no particular virus or bacteria that is considered a high risk. Thus, the problem appears to be in the immune system itself. Abnormal amounts of the immunoglobulin IgA are found in the blood vessels and organs affected by the condition. Vasculitis is an active area of research, with 132 clinical trials currently in progress.
Vascular purpura clears up by itself in most cases. However, it may recur, and in rare cases, it can cause kidney failure or a bowel obstruction called intussusception. Hospitalization is recommended in the following situations:
1. Dehydration from bowel inflammation. Oral intake of fluids may not be sufficient to maintain adequate hydration.
2. Severe abdominal pain or significant gastrointestinal bleeding.
3. Joint pain and inflammation severe enough to limit the patient's ability to walk or function in daily activities.
4. Kidney damage indicated by high creatinine in the blood, high blood pressure, and nephrotic syndrome.
Treatment includes nonsteroidal anti-inflammatory drugs and glucocorticosteroids, such as prednisone or methylprednisone. When kidney damage is evident from blood and urine tests, the patient should be evaluated for kidney function for an extended period of time after the other symptoms have cleared up.
Sources:
Photos of the rash provided by Johns Hopkins University:
http://vasculitis.med.jhu.edu/typesof/hsp.htm
Vasculitis Foundation information on vascular purpura:
http://www.vasculitisfoundation.org/HenochSchonleinpurpura
Clinical trials on vasculitis:
http://clinicaltrials.gov/ct2/results?term=vasculitis
Lim, DCE et al, “Could it be Henoch-Schonlein purpura?” Australian Family Physician May 2009; 38(5): 321-324.
Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.