An 8 year old male had non blanching rashes over the shin and swelling of knee joint with haematuria +++ and protein +. Microscopic analysis of his renal biopsy specimen is most likely to show.
Ans. is 'c' i.e. Mesangial deposits of IgA Purpura in Henoch Schonlein purpura is due to vasculitis and not thrombocytopenia Platelet count is either normal or elevated.H.S. purpura is characterized by tetrad ofPurpura Q,Arthritic,GlomerulonephritisQ andAbdominal painQ.Skin7%e hallmark of this disease is rash beginning as pinkish maculopapules that initially blanch on pressure and progress to petechiae or purpura which are characterized clinically as palpable purpura Q.The lesion tends to occur in crops Q.The lesion occur on the dependent areas of the body such as buttocks Q.Joints (80%)Manifests as arthralgia or arthritis in large jointsLarge joints of lower extremities are involved especially the knees and the ankles. Migratory Q pattern of joint involvement is commonArthritis is non deforming Q in natureGastrointestinal tract 60%presents with abdominal painQ33% have evidence of gastrointestinal bleeding Q(melena)Abdominal pain is typically colicky QMay worsen after angina Q(intestinal angina)Can lead to intussusception Q.Kidney (40%)Almost always appear after the development of skin manifestationThe clinical hallmark of nephritis in HSP is hematuria which is usually microscopicStudies characteristically demonstrate IgA deposition in the mesangium.Diagnosis of H.S. PurpuraDiagnosis is based upon signs and symptomsSkin biopsy demonstrates leukocytoclastic vasculitis with IgA and C3 deposition.Renal biopsy may be helpful.
Tubular necrosis
Visceral podocyte fusion
Mesangial deposits of IgA
Basement membrane thickening
Nephropathy