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IgA vasculitis (HSP) — the purple rash, joint pain, belly pain, and the kidney involvement that decides the long-term outcome. The monitoring rules parents need.
Evidence reviewed & updated: 2026-08 — reflects the latest published trials and guidelines.
Henoch-Schonlein purpura (HSP, now called IgA vasculitis) is the most common vasculitis of childhood — the classic purple rash on the buttocks and legs, joint pain, and belly pain. Kidney involvement (HSP nephritis) decides the long-term outlook: most children have mild urine findings that settle, but a minority develop progressive kidney disease and need treatment.
HSP is an IgA-mediated small-vessel vasculitis — the same antibody family as IgA nephropathy, which is why the kidney findings overlap. The rash (palpable purpura on buttocks and legs) is the calling card, with joint and belly pain following; kidney involvement develops in a third to half of children, usually within the first month.
The pattern: blood in the urine (often microscopic), sometimes protein — occasionally nephrotic-range. The spectrum runs from 'clears on its own' to progressive glomerulonephritis.
The urine is the entire game: urine dipsticks (blood, protein) and blood pressure checks at diagnosis, then weekly to monthly in the first months, then graduated. The nephrologist's thresholds: persistent proteinuria (especially nephrotic range) or falling eGFR trigger treatment — not the rash.
Parents' checklist: keep the dipstick log, watch for puffy eyes or swelling, and report dark urine, headache, or high BP. The disease can linger in the kidneys after the skin clears — monitoring continues for months regardless of the rash.
Mild nephritis (isolated blood in urine, no or low protein): observation — most resolves completely. Moderate-severe (nephrotic-range proteinuria, declining function, or crescents on biopsy): steroids, often with immunosuppression, following the same protocols as severe IgA nephropathy.
Long-term: the majority of children recover fully. The minority with progressive disease need the full CKD playbook, and anyone with persistent proteinuria after HSP deserves years of urine surveillance — not a 'cleared' stamp.
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