Henoch-Schönlein Purpura with IgA Vasculitis Nephritis and Mild Proteinuria: What to Do When Oral Prednisolone Has Not Achieved Renal Remission
This protocol addresses the management of Henoch-Schönlein purpura presenting with IgA vasculitis nephritis at the mild end of the spectrum — specifically when initial treatment has not produced the renal remission benchmarks expected at 12 months.
Clinical scenario: IgA vasculitis nephritis with normal eGFR (>90 mL/min), mild or moderate proteinuria, and microscopic haematuria — meeting criteria for mild nephritis.
Escalation from first-line therapy
This next-line protocol applies when oral prednisolone — used for IgAV with mild nephritis — has not secured stable renal remission at 12 months. Escalation is indicated when any of the following targets remain unachieved:
- 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
The approach in this setting involves second-line immunosuppressive therapy for resistant or non-responding cases; the specific agent selection and management algorithm are detailed in the full protocol.
References
Mild: Normal eGFR (>90 mL/min) and mild or moderate proteinuria, microscopic haematuria.
Second line: Azathioprine, mycophenolate mofetil, pulsed methylprednisolone (in resistant non responding cases).
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