An 8-year-old girl with Henoch-Schonlein purpura has palpable purpura over the buttocks, arthralgia, and microscopic hematuria at presentation. At follow-up she has persistent proteinuria exceeding 1 g/day after 4 weeks despite normal blood pressure. What is the most appropriate next step?
- A Continue observation with monthly urinalysis alone
- B Perform a renal biopsy to grade the lesion ✓
- C Start empiric cyclophosphamide without further evaluation
- D Administer a course of oral antibiotics
Correct answer: B. Perform a renal biopsy to grade the lesion
Explanation
Children with HSP nephritis who develop nephrotic range proteinuria, persistent heavy proteinuria, hypertension, or rising creatinine require renal biopsy, since the International Study of Kidney Disease classification guides therapy based on histology. Observation alone is reserved for isolated hematuria or trivial proteinuria. Empiric cyclophosphamide before histological staging is inappropriate because proliferative lesions such as crescentic disease need regimen decisions based on biopsy findings.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.