HENOCH SCHONLEIN PURPURA

  mY QUESTION WAS REFERRED OVER TO THIS SECTION FROM GENERAL FORUM, SO I AM HOPING NOT TO HAVE TO WAIT TO LONG FOR A RESPONSE. IN FEB. 1998 MY 12 YEAR OLD SON WAS DIAGNOSED WITH HSP.  HE HAD DEVELOPED BRUISING AND RASHES ALL OVER HIS FEET, LEGS BUTTOCKS, ARMS AND A LITTLE BEHIND HIS EARS.  THE ARMS HAD DEVELOPED INTO WHAT APPEARED TO BE LARGE BLOOD BLISTERS. HE ALSO HAD SEVERE SWELLING IN HIS ARMS BUT ESPECIALLY HIS LEGS.  HIS RIGHT LEG HAD SWELLED TO THE POINT THAT HE COULD NOT WALK FOR ALMOST A WEEK. IT TOOK APPROXIMATELY THREE WEEKS FOR HIS TO BEGIN RECOVERING,WHEN HE DEVELOPED ANOTHER OUTBREAK MAINLY ON HIS FEET UPPER LEGS AND THE BACK OF HIS ARMS. OUR PEDIATRICIAN NEVER FULLY EXPLAINED THE DISEASE TO US OR ANY POSSIBLE LONG TERM EFFECTS. THE PEDIATRICIANS NURSE WAS THE ONE WHO HAD SAID MY SON WOULD NEED FOLLOW UP URINE TESTS FOR SOME MONTHS TO COME. WHEN I ASKED MY PEDIATRICIAN ABOUT FOLLOW UP TESTS HE SAID IT WAS TOTALLY UNNECESSARY UNLESS I COULD SEE THE BLOOD IN HIS URINE OF AFTER A BOWEL MOVEMENT. IT IS NOW OCTOBER AND MY SON IS GETTING OVER A BAD COLD WITH FEVER SWOLLEN GLANDS(ALTHOUGH I DID NOT GIVE HIM PRESCRIBED ANTIBIOTICS), HE ALSO HAD A BAD STOMACHACHE AND VOMITING. AT THE START OF HIS COLD I TOOK HIM TO A WALKIN MEDICENTRE AND ASKED FOR A URINE TEST TO CHECK FOR ANY SIGN OF HSP. THE DR. PHONED LAST NIGHT AND INFORMED ME THAT THERE WAS SOME BLOOD IN HIS URINE TEST. NO PROTEIN WAS REPORTED, BUT I SHOULD TELL YOU THAT IN THE FEB. OUTBREAK HE DID HAVE PROTEIN IN HIS URINE WHICH THE PEDIATRICIAN SAID WAS TO BE EXPECTED BUT THERE WAS NO MENTION OF BLOOD AT THAT TIME.  I HAVE LEARNED QUITE A BIT ABOUT THE DISEASE THROUGH THE INTERNET BUT I DO NOT KNOW OR REALLY UNDERSTAND THE SIGNIFICANCE IF ANY ABOUT THIS BLOOD IN THE URINE. COULD YOU PLEASE ADVISE ME ON WHAT THIS MIGHT MEAN. AND WHAT MY NEXT MOVE SHOULD BE
  THANK YOU

Dear Gwen:
Henoch-Schoenlein Syndrome (HSS) is a disease of small blood vessels whose cause remains unknown. Fortunately, your son appears to have recovered well, despite his frightening initial experience and the recurrence.
Kidney involvement is common, and often more severe in older children and adolescents. However, if microscopic hematuria (red blood cells in the urine seen only under magnification) is the exclusive manifestation of kidney disease, no long-term damage is likely. You stated in your note that protein but no blood was found when the disease first presented. It is important to be clear about how much protein was
present, since small amounts may be unrelated to kidney disease. Your son's doctor should be able to tell you if there were any other signs of kidney disease at the time. If there were, long-term follow-up is necessary to assure that renal impairment does not develop over time. However, if no conclusive evidence of kidney involvement was present, the outlook is exceedingly bright and follow-up can be much more limited.
The blood found in the urine at the urgent care center may reflect only the acute illness he was experiencing and not be connected to any problem with his kidneys. Again, quantitation is important.
You are probably aware that your son could still have another recurrence of HSP and still do very well.
I hope this information proves helpful. It is presented for educational purposes only.
HFHS.MD-HSW
KEYWORDS: Henoch-Schoenlein Purpura