Henoch Schonlein Purpura：过敏性紫癜.docVIP

Paediatric Clinical Guidelines Renal 6.5 October 2001 Guideline for the Management of Henoch Sch?nlein Purpura (HSP) Background: HSP is the most common vasculitic disease of childhood Incidence: 18 per 100,000 children Affects pre-school children predominantly (50% 5yrs) Males females Commoner during winter to early spring Clinically: HSP is a multi-system disorder affecting: Skin purpuric rash (may initially be urticarial) On limbs (extensor surfaces) and buttocks Joints 60-80% Ankles and knees most commonly Transient G.I 50-70% Colicky abdominal pain Nausea vomiting Intestinal haemorrhage Intussusception (Pancreatitis) Renal 20-100% Haematuria (microscopic +/- macroscopic) Proteinuria Hypertension (may occur without urine abnormalities) Impaired renal function Cerebral headaches Seizures Coma Others Scrotum (30%) ΔΔ testicular torsion Lung Diagnosis: Usually clinical Differential diagnosis: Any cause of a non-blanching rash SLE Wegeners Microscopic polyarteritis Investigations: No specific diagnostic test ALL children require: Urine dipstick Blood pressure ONLY consider the following if uncertainty about diagnosis FBC Clotting UE Autoantibodies Admit if: Severe symptoms of joint pain Severe abdominal pain G I haemorrhage Neurological symptoms Evidence of acute glomerulonephritis, nephrotic syndrome or abnormal renal function Clinical course: HSP is usually self-limiting (most remit within 6 weeks). A small minority may relapse Mortality 1% Long term morbidity is related to renal involvement If the kidneys are involved, this usually manifests within 3 months from the date of onset – but can present up to 12 months later Management: Joint symptoms: simple analgesia: Paracetamol, NSAIDS – avoid if hypertensive or significant proteinuria Abdominal pain: simple analgesia Severe gut involvement; oral Prednisolone 1mg/kg/day (max 60mgs) for 1 – 2 weeks Renal involvement: See flow sheet for summary If initial urinalysis shows 2+ proteinuia o