IgA Vasculitis Nephritis with <50% Crescents on Renal Biopsy: Next-Line Treatment After Corticosteroids

Clinical scenario

This protocol applies to patients with IgA vasculitis (Henoch-Schönlein purpura) nephritis where renal biopsy shows fewer than 50% crescents, alongside impaired eGFR (60–89 mL/min/1.73 m²) or severe persistent proteinuria — a moderate nephritis presentation requiring escalation beyond initial corticosteroid therapy.

Previous treatment & reason for escalation

First-line therapy with oral prednisolone and/or pulsed intravenous methylprednisolone did not achieve stable renal remission at 12 months. The goals that were not reached:

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

Next-line approach (partial overview)

The next step involves adding an immunosuppressive agent to ongoing corticosteroid management — the structured protocol specifies which agents apply in this setting and how the regimen is built.

Full regimen details, sequencing, and supporting evidence are available via the link below.

Instant Access to Structured Evidence-Based Regimens

References

Moderate: <50% crescents on renal biopsy and impaired eGFR (60–89 mL/min) or severe persistent proteinuria

Second line (can be added to 1st line of management): Azathioprine, mycophenolate mofetil, IV cyclophosphamide

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