An 8 year old child is brought with c/o severe abdominal pain. O/E palpable purpura is noted. There is history of recent diarrhea which is completely resolved. What is the expected pathological finding in kidney?
HENOCH SCHONLEIN (ANAPHYLACTOID) PURPURA • Most common systemic vasculitis in children
• 90% cases occur in the age group 3 to 10 years • Immune complex deposition causing small vessel vasculitis
• Many cases of HSP follow a documented upper respiratory infection Characterized by the tetrad of
• Palpable purpura (due to vasculitis, not due to thrombocytopenia) - occur in gravitydependent areas (lower extremities) or on pressure points (buttocks)
• Polyarthralgia in the absence of arthritis (non-deforming, oligoarticular, involves large joints, migratory)
• Gl symptoms (colicky abdominal pain, passage of blood and mucus per rectum, intussusception) - in 80% children
• Mild glomerulonephritis (IgA deposition in the mesangium, microscopic hematuria) - in 50% children
• Chronic renal disease develops in 1-2% of children with HSP • Approximately 8% of those with HSP nephritis go on to have end-stage renal disease
• Myocardial involvement can occur in adults but is rare in children Laboratory features • ANCA negative
• Leukocytoclastic vasculitis with IgA deposition in the small vessels in the skin, joints, gastrointestinal tract & kidney
• Deposition of C3, fibrin, and IgM are also seen to a lesser extent • Elevated ESR • Normal platelet count
• Normal complement levels Diagnosis, prognosis and treatment • No laboratory finding is diagnostic of HSP; The diagnosis of HSP is a clinical one
• Treatment for mild and self-limited HSP is supportive • Steroids are most often used to treat significant gastrointestinal involvement or other lifethreatening manifestations
• Predisone: useful in decreasing tissue edema, arthralgias, and abdominal discomfort; but does not alter overall prognosis nor prevent renal disease.
• The prognosis is excellent ❖ Deposits of IgA are also found in the glomerular mesangium in a variety of systemic diseases, including chronic liver disease,
Crohn's disease, gastrointestinal adenocarcinoma, chronic bronchiectasis, idiopathic interstitial pneumonia, dermatitis herpetiformis, mycosis fungoides, leprosy, ankylosing spondylitis,
relapsing polychondritis, and Sjogren's syndrome.
Podocyte effacement on electron microscopy
Electron dense deposits in the Glomerular basement membrane on electron microscopy
Hypercellular glomeruli with neutrophils on light microscopy
Mesangial deposits of IgA on electron microscopy