Treatment of IgA Vasculitis Nephritis with <50% Crescents on Renal Biopsy in Henoch-Schönlein Purpura
When Henoch-Schönlein purpura is complicated by IgA vasculitis nephritis and renal biopsy reveals fewer than 50% crescents alongside impaired kidney function or significant proteinuria, a structured first-line approach is indicated to prevent further renal deterioration.
Clinical scenario
IgA vasculitis nephritis with <50% crescents on renal biopsy, combined with impaired eGFR (60–89 mL/min) or severe persistent proteinuria. This moderate-severity renal presentation defines the specific population for this protocol.
The first-line treatment approach involves corticosteroid therapy — the specific agents, modes of administration, and sequencing are set out in the full protocol.
Treatment goals (12-month remission targets)
- eGFR >60 mL/min/1.73 m²
- Urinary protein-to-creatinine ratio <30 mg/mmol
- Proteinuria <1+ on dipstick
- Haematuria <5 red cells per high power field or <2+ on dipstick
References
Moderate: <50% crescents on renal biopsy and impaired eGFR (60–89 mL/min) or severe persistent proteinuria
1st line: oral prednisolone and / or pulsed methylprednisolone
Disease symptoms should be in stable remission for 12 months. An eGFR >60 mL/min/1.73 m². UP:UC <30 mg/mmol. Proteinuria <1+ on dipstick and haematuria <5 red cells per HPF or <2+ on dipstick with a prednisolone dose <5 mg/day.
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