Clinical Profile, Renal Involvement, and Relapse Patterns in Pediatric Henoch–Schönlein Purpura: A Retrospective Observational Study from a Tertiary Care Centre in South India

Abstract

Highlights: What are the main findings? In this five-year, single-centre South-Indian pediatric cohort of Henoch–Schönlein purpura (HSP; n = 41), palpable purpura was universal, most often on the lower limbs (~95%), with frequent joint involvement (73.1%) and abdominal pain (61.0%) at presentation. Renal involvement occurred in 17% and was observed only in children aged ≥6 years, typically as microscopic haematuria with proteinuria (ISKDC II–III in the two biopsied cases). Rash relapse was uncommon (7.3%) and clustered with joint and abdominal symptoms at baseline; no relapsed child had nephritis, suggesting that the biology of cutaneous recurrence and renal morbidity may differ. Management reflected severity (NSAIDs 71.6%, corticosteroids 31.7%, dapsone 24.4%), and renal outcomes were favourable at a mean 18.9-month follow-up (one child on long-term antihypertensives; no progression to end-stage renal disease). Clinically, these data support age-targeted urine and BP surveillance from ≥6 years. It also indicates that relapse risk tracks with systemic (joint/abdominal) features rather than renal disease. What is the implication of the main finding? Age ≥6 years should be treated as a pragmatic bedside flag for nephritis risk in HSP. Prioritize early and frequent surveillance (urine dipstick and blood pressure weekly for the first month, then monthly up to 6 months). Concurrent joint and abdominal symptoms at onset identify children at higher risk of cutaneous relapse rather than renal disease; plan relapse-focused follow-up and counselling accordingly. Routine inflammatory markers (ESR/CRP) were not predictive of nephritis and should not replace targeted clinical monitoring. Background/Objectives: Henoch–Schönlein purpura (HSP), or IgA vasculitis, is the most common small-vessel vasculitis in children, yet Indian cohort data remain limited. We aimed to describe the clinical profile, renal involvement, treatment patterns, relapse, and outcomes of pediatric HSP at a tertiary centre in South India. Methods: We conducted a retrospective review of children <18 years diagnosed with HSP (January 2013–October 2018) using EULAR/PRINTO/PRES criteria. Demographics, clinical features, laboratory parameters, treatments, and outcomes were abstracted from records and analyzed in SPSS (descriptive statistics; Chi-square/Fisher’s exact and t/non-parametric tests as appropriate). Subgroup comparisons included renal vs. non-renal disease and age <6 vs. ≥6 years. An exploratory analysis examined predictors of nephritis. Results: Of 43 children identified, 2 were excluded (misclassified as systemic lupus erythematosus); 41 were analyzed. Mean age was 8.5 years (range 3–17), male: female 1.4:1. A preceding febrile illness or upper respiratory tract infection was noted in 41.4% and 17%, respectively. Palpable purpura was universal; joint involvement 73.1%, abdominal pain 61.0%, vomiting 41.5%. Renal involvement 17% occurred only in children ≥6 years; exploratory testing supported a strong age-linked signal for nephritis. Laboratory abnormalities included anemia (48.7%), thrombocytosis (19.5%), and elevated ESR (51.2%). Skin biopsy (n = 29) showed IgA and complement deposition; renal biopsy (n = 2) showed ISKDC grades II–III. Treatments included NSAIDs 71.6%, corticosteroids 31.7%, and dapsone 24.4% (used for severe systemic/persistent cutaneous disease). Rash relapse 7.3% clustered with joint plus abdominal symptoms and was not observed among children with nephritis. At a mean 18.9-month follow-up, one child required long-term antihypertensives; no child progressed to end-stage renal disease. Conclusions: Pediatric HSP in this South-Indian cohort followed a largely self-limited course with favourable renal outcomes. Age ≥6 years flagged higher renal risk, supporting age-targeted urine and blood-pressure surveillance, while relapse appeared to follow a non-renal trajectory (joint/abdominal clustering). Steroid and dapsone use reflected clinical severity rather than relapse risk. Findings align with Indian series and suggest lower renal morbidity than some East-Asian reports, adding region-specific evidence to guide monitoring and counselling.