An adult patient with IgA vasculitis (Henoch-Schonlein purpura) has palpable purpura and arthralgia. Urinalysis shows proteinuria of 1.8 grams per day with an active urinary sediment. What is the most appropriate next step?
- A Renal biopsy to assess the degree of nephritis ✓
- B Reassurance with follow-up urinalysis in six months
- C Empirical antistreptolysin O titration only
- D Immediate splenectomy
Correct answer: A. Renal biopsy to assess the degree of nephritis
Explanation
Renal involvement determines long-term prognosis in IgA vasculitis, and adults fare worse than children. Significant proteinuria, generally exceeding 0.5 to 1 gram per day, hypertension, or impaired renal function mandates renal biopsy to grade the nephritis and guide immunosuppressive therapy, since crescentic disease needs aggressive treatment. Observation alone risks progression to end-stage renal disease. ASO titres help document preceding streptococcal infection but do not stage renal disease, and splenectomy has no role.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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