A Typical Renal Manifestation of Henoch – Schonlein Purpura in A Child: A Case Report

Abstract

Henoch–Schönlein purpura (HSP), currently termed IgA vasculitis, is the most common small-vessel vasculitis in children. It is characterized by non-thrombocytopenic palpable purpura, arthritis or arthralgia, gastrointestinal manifestations, and renal involvement. Although the disease is generally self-limiting, renal involvement can lead to significant long-term morbidity and requires early recognition and appropriate management.

We report the case of a 10-year-old female who presented with palpable purpura over both lower limbs, bilateral lower-limb edema, hematuria, and proteinuria following a recent upper respiratory tract infection. Laboratory investigations demonstrated significant urinary abnormalities suggestive of renal involvement. Skin biopsy revealed features of small-vessel vasculitis, while renal biopsy demonstrated IgA-dominant immune complex deposition predominantly within the glomerular mesangium, confirming IgA vasculitis with nephritis. In view of the significant renal involvement, the child was treated with corticosteroids and azathioprine, following which clinical and laboratory improvement was observed.

This case highlights IgA vasculitis presenting with prominent renal involvement requiring histopathological confirmation and immunosuppressive therapy. Early identification and appropriate assessment of renal involvement, timely renal biopsy in selected patients, and multidisciplinary management are essential to reduce the risk of progressive renal disease and improve long-term outcomes in children with IgA vasculitis.