Children and adolescents
IgA vasculitis (Henoch-Schönlein purpura)
The most common childhood vasculitis: leg and buttock purpura with joint, gut and kidney involvement. Usually self-limited.
What to look for
- Purpura or petechiae with lower-limb predominance (mandatory for EULAR/PRINTO/PReS classification), often palpable, on the legs and buttocks
- Arthralgia or arthritis, colicky abdominal pain (GI bleeding, intussusception risk)
- Hematuria or proteinuria. Nephritis can appear weeks to months later. Peak age is 3–10.
What to do
- First exclude infection: fever, an ill-appearing child or a rapidly spreading non-blanching rash needs emergency assessment for sepsis.
- Most well children recover within weeks. Manage pain supportively.
- Monitor urinalysis and blood pressure for at least 6–12 months from onset (SHARE 2019), more often in the first weeks. Involve pediatric nephrology once nephritis is confirmed (KDIGO 2025).
- Refer urgently for significant proteinuria, nephrotic or nephritic features, rising creatinine or severe GI disease. Refer for recurrent or atypical episodes.
About this urgency level
Early specialist assessment changes outcomes. Send the usual workup with the referral, but don't hold the referral while waiting for results.
Timeframes are typical targets. Local pathways, capacity and clinical judgment come first.