title: Henoch schonlein purpura--a 5-year review and proposed pathway.
abstract: Henoch Schonlein Purpura (HSP) is the commonest systemic vasculitis of childhood typically presenting with a palpable purpuric rash and frequently involving the renal system. We are the first group to clinically assess, critically analyse and subsequently revise a nurse led monitoring pathway for this condition.A cohort of 102 children presenting with HSP to a secondary/tertiary level UK paediatric hospital over a five year period, were monitored using a nurse led care pathway. Using this cohort, the incidence (6.21 cases per 100,000 children per year) and natural disease course of HSP nephritis (46% initial renal inflammation; 9% subsequent renal referral; 1% renal biopsy and immunosuppression) was determined. Older patients were at higher risk of requiring a renal referral (renal referral 12.3 (8.4-13.5) years vs. normal outcome 6.0 (3.7-8.5) years; p<0.01). A normal urinalysis on day 7 had a 97% (confidence interval 90 to 99%) negative predictive value in predicting a normal renal outcome.Using this data and existing literature base, The Alder Hey Henoch Schonlein Purpura Pathway was developed, a revised pathway for the screening of poor renal outcome in HSP. This is based on a six-month monitoring period for all patients presenting with HSP, which importantly prioritises patients according to the urine findings on day 7 and thus intensively monitors those at higher risk of developing nephritis. The pathway could be easily adapted for use in different settings and resources.The introduction of a standardised pathway for the monitoring of HSP will facilitate the implementation of disease registries to further our understanding of the condition and permit future clinical trials.
authors.affiliation: Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, United Kingdom. Louise.watson@liv.ac.uk
authors.forename: Louise
authors.initials: L
authors.lastname: Watson
authors.forename: Amanda R W
authors.initials: AR
authors.lastname: Richardson
authors.forename: Richard C L
authors.initials: RC
authors.lastname: Holt
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Jones
authors.forename: Michael W
authors.initials: MW
authors.lastname: Beresford
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications; D011695:IgA Vasculitis / Q000150:complications / Q000175:diagnosis* / Q000652:urine; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009393:Nephritis / Q000150:complications / Q000175:diagnosis; D011237:Predictive Value of Tests; D011507:Proteinuria / Q000150:complications