A 9-year-old boy with Henoch-Schonlein purpura has a resolving rash and abdominal pain. Urine examination done weekly shows proteinuria persisting at 3+ for 4 weeks with spot urine protein to creatinine ratio of 3.5 mg/mg and blood pressure at the 95th percentile. What is the next step in management of the renal involvement?

• A Continue supportive care and monthly urine examination only
• B Start penicillin prophylaxis and restrict dietary sodium
• C Begin empirical cyclophosphamide without histological assessment
• D Refer for kidney biopsy and consider corticosteroid therapy for nephritis ✓

Explanation

Persistent nephrotic-range proteinuria, hypertension, or rising creatinine in IgA vasculitis indicates significant glomerular injury and mandates renal biopsy to grade the lesion before immunosuppressive treatment, usually steroids with or without additional agents. Supportive monitoring alone is appropriate only for mild isolated hematuria or trace proteinuria, and starting cyclophosphamide without biopsy evidence of severe proliferative disease is unjustified.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.