Henoch-Schönlein Purpura


  • Most common childhood systemic vasculitis; rare in adults.

  • Reported annual incidence varies between 10-30 cases per 100,000 in children younger than 17 y and 3.4–14.3 cases per million in adults.

  • Mean age of presentation is 6 y; mainly affects children between 4-11 y of age in up to 90% of cases.

  • Occurs most commonly in spring; associated with recent URTIs in 90% of cases.

  • Cases are reported all over the world; highest incidence is found in Caucasians and lowest in African Americans in North America.

Perioperative Risks

  • Morbidity/periop complications increase with abnormal renal function and neurologic/pulm/cardiovascular involvement/emergency surgery.

Worry About

  • Problems of concurrent supportive medications (NSAIDs, immunosuppressants, steroids, ACE inhibitors) that the pt may be taking

  • Hypoproteinemia due to proteinuria if renal involvement

  • Anemia due to hematuria if renal involvement and GI bleeding

  • Fluid and lyte imbalance due to N/V and renal involvement


  • HSP is an acute, self-limiting, autoimmune, small vessel childhood vasculitis commonly affecting those of the dermis, bowel wall, and rarely the ureter, myocardium, adrenals, brain, and lungs. Glomerular mesangial hypercellularity with endocapillary proliferation occurs commonly.

  • It begins commonly with a nonthrombocytopenic purpuric rash. Arthritis or arthralgia is present in three-quarters of children and approximately 61% adults. GI symptoms occur in up to 85% of children and 48% of adults. Renal involvement is seen in 20–55% of children and approximately 32% of adults. GN is seen in a third of cases and may manifest as isolated hematuria, hypertension, or nephritic/nephrotic syndrome. 1–5% of children and 50% of adults with renal involvement progress to ESRD. Renal failure is the most common cause of death. The disease usually runs its entire course in 4 wk, and many children have no permanent sequelae. Renal symptoms can develop up to 3 mo after initial presentation. The course is complicated in adults.

  • HSP is a clinical Dx, and none of the laboratory features are pathognomonic. Palpable purpura plus at least one feature like diffuse abdominal pain/IgA deposition in any biopsy/arthritis/renal involvement suggests the Dx.

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