Most children with HSP do not need special treatment. They are carefully monitored by a team of healthcare professionals at the hospital. Most children recover from HSP after a few weeks or a few months – the purpura (rash), joint pains and stomach pains disappear.
Some children need treatment – for pain, complications or kidney problems – which are explained below.
It is important that your child follows any treatment plan outlined by your doctor.
Questions to ask the doctor or nurse
- What treatment does my child need?
- How will the treatment help my child?
- How long will my child be in hospital?
- How can I help my child prepare for procedures and treatments?
- If the first treatment does not work in my child, what happens next?
- How will I know if we need to go back to the hospital or see the doctor?
- Will the HSP come back? How will I know?
Where will my child be treated?
Your child will probably be treated in a paediatric unit, a special part of your hospital for children. He or she will be looked after by a paediatrician, a doctor who treats babies, children and young people.
Your child may need to stay in hospital for a few days or longer. However, children with HSP usually have most of their care as an outpatient, visiting the hospital during the day.
Referral to specialist care
A few children are referred to a paediatric renal unit, a specialised unit that treats babies, children and young people with kidney problems and may be in a different hospital to your own. They are looked after by a paediatric nephrologist, a doctor who treats children with kidney problems.
Managing pain and nausea
To help manage any joint or tummy pain, your child may take medicines such as paracetamol.
You can get paracetamol or other medicines for pain from your pharmacist, in a form that is best for your child. Make sure you follow the instructions given with the medicine. Wait at least 4 hours between doses of paracetamol, and do not give more than four doses in 24 hours.
About paracetamol for mild-to-moderate pain (Medicines for Children)
Speak with your doctor or nurse if you need more support.
Do not give your child ibuprofen (e.g. Brufen) – this medicine may cause further damage to kidneys that are affected by HSP.
Reducing protein loss in urine and controlling blood pressure
Some children need to take medicines for:
- proteinuria – to reduce the amount of protein lost in their urine, and/or
- hypertension – to reduce or control blood their pressure so it is in the healthy range.
These are usually medicines called angiotensin-converting enzyme inhibitors (ACE inhibitors) or angiotensin-II receptor blockers (ARBs). Common ACE inhibitors are: captopril, enalapril and lisinopril.
Research suggests that, in some children, these medicines will reduce the risk of long-term kidney problems.
It is important that you follow your doctor’s instructions about when and how much to give. Do not stop the medicine suddenly.
Steroid medicines
Your paediatrician may prescribe steroid medicines to your child – this is usually the medicine prednisolone. This is usually for children with:
- severe stomach pain
- swelling in their body (oedema) when the kidneys leak a lot of protein
- significant proteinuria for more than four weeks
- acute kidney injury – when the kidneys stop working properly over a short time.
Steroids are chemicals that are made naturally in the body but can also be made as medicines. They suppress the immune system – stop it from working to avoid harming the body.
How to give medicines
Your doctor will let you know how often and for how long to give the medicine. He or she will work out the amount of medicine (dose) that is right for your child – this will be shown on the medicine label.
It is important that you follow your doctor’s instructions about when and how much to give. Do not stop the medicine suddenly.
Vaccines
It is important that your child has the vaccines (immunisations) that he or she needs to reduce the risk of some diseases. Speak with your doctor about these – some vaccines (live vaccines) are not safe to give while a child is taking steroids.
Infections
Children taking these medicines are more likely to get infections. Speak with your doctor or nurse, and your child’s teacher or daycare manager, about how you can help prevent infection. Contact your doctor straight away if your child:
- has been in contact with someone who has chicken pox (if they have not had this illness before) or measles (if they have not had the MMR vaccine, which protects against measles, mumps and rubella); or
- is unwell and you are worried about an infection.
If your child does get an infection, he or she may need to take an antibiotic medicine, which kills the germs that cause infection. Your child must take the medicine for the number of days that the doctor has told you, or until all of the medicine has been taken.
More about antibiotics (Medicines for Children)
Side-effects you need to do something about
We use medicines to help children get better, but sometimes they have effects we do not want – side-effects.
Contact your doctor straight away if your child has any of the following while on steroid medicines:
- fever (temperature above 38°C), with a sore throat or a cough, for more than 12 hours
- a rash or severe bruising
- bad stomach pain or repeated vomiting – sometimes steroids can cause ulcers in the stomach.
Other side-effects
Other side-effects that affect some children are below – speak with your doctor or nurse if you are concerned or need more support:
- nausea, vomiting, stomach pain and/or indigestion (heartburn) due to irritation to the lining of the stomach – your doctor may give your child some medicine to treat this
- behavioural problems – you may find that your child is more likely to have tantrums, be moody, feel depressed, have difficulty sleeping or have nightmares
- weight gain and larger appetite – you can help by making sure your child has lots of physical activity and eats fruits, vegetables and low-calorie food, rather than food that is high in calories (such as cakes, biscuits, sweets and crisps), and by reducing the portion size
- high blood pressure (hypertension) – your child’s blood pressure will be regularly checked, and if it is too high, will need to be controlled by eating a diet with no-added salt.
There may, sometimes, be other side-effects that are not listed above. If you notice anything unusual and are concerned, contact your doctor.
When steroids are needed over a long time, or in high doses, they may have other side-effects.
More information about side-effects of long-term use of steroids
When steroids are needed over a long time, or in high doses, they may have other side-effects. If you have any concerns, talk to your doctor.
- All steroid medicines, including prednisolone, may affect the adrenal glands so that they produce less of a hormone called cortisol when the body is stressed (e.g. during illness or injury). This means that your child may have more difficulty fighting off an infection, or may recover less quickly from injury or after surgery. If your child is unwell and you are worried about an infection, contact your doctor straight away.
- Steroids can slow growth and affect puberty. They can also cause growth of body hair and irregular periods in girls. Your doctor will check your child’s growth and development.
- Your child’s skin may become thinner, and heal more slowly than usual. Acne (spots) may become worse, or your child may develop mouth ulcers or thrush (candidiasis).
- Your child may develop problems with their hip bones, or their bones may become weaker (osteoporosis). The muscles around their hips and shoulders may also become weaker. If your child has any difficulty walking or moving around, contact your doctor.
- Occasionally, steroids cause diabetes. If your child seems more thirsty than normal, needs to pass urine (wee) often, or starts wetting the bed at night, contact your doctor.
Changes to eating and drinking
Children who have oedema, are taking steroids or have acute kidney injury may need to make temporary changes to what they eat and drink. For example, they may need to eat a no-added salt diet and less of certain foods, and/or drink less fluid, such as water, squash and soft drinks.
More information about a no-added salt diet
Eating too much salt can worsen oedema (swelling in the body) and can increase the risk of developing hypertension (high blood pressure), especially while on steroid medicines.
Your child should avoid eating or drinking lots of salted nuts, crisps, crackers, soft drinks, fast food meals, takeaways and processed foods (meals that are pre-prepared, including soups) – these often have more salt than we think. Do not add extra salt to meals that you cook or at the dining table.
Your doctor, nurse or a paediatric dietitian at the hospital will be able to give you more information
Managing reduced kidney function
Some children with HSP develop reduced kidney function, which means that their kidneys do not work as well as normal. The severity of this varies, but most do not need any special treatment and their kidney function will return to normal.
A very small number will have more serious kidney problems and will need dialysis. This uses special equipment or a machine to do what a healthy kidney does – remove waste products and excess water from the body. Most of these children need this treatment for a short time only, but a few need it for longer.
Your healthcare team will speak with you and your family about any long-term effects your child might have with HSP.
Urine testing at home
Your doctor may ask you to do urine tests at home to find out whether the HSP nephritis (HSP with kidney involvement) has gone away (gone into remission). You will be given special, clean containers to collect the urine and dipsticks to dip into the urine and check for any proteins and/or blood in the urine.
Your child’s healthcare team will show you how to do this.
Remission and relapse
Remission
When the HSP goes away, this is called remission. In most children the symptoms and signs of HSP go away within one month. Some children may have problems for up to three months or longer.
The purpura on the skin disappears – and usually does not leave any scars – and the joint pains and tummy pains go away. For children with HSP nephritis (where the kidneys are involved), your doctor will check for continued protein and/or blood in their urine.
Relapse
In a few children, the symptoms and signs come back, usually within one year. This is called a relapse. These children may need to go back to the hospital, and may need further treatment.
Follow up
All children who have been treated for HSP affecting their kidneys will have follow-up appointments throughout their childhood. It is important to go to these appointments even if your child seems well. You will also have the opportunity to ask any questions. At these appointments, your child may have:
- his or her height and weight checked, and blood pressure measured.
- a physical examination
- urine tests – to check for blood and protein in his or her urine
- blood tests – to check for the amount of protein and other substances in his or her blood, and measure his or her kidney function.
Long-term effects
Most children have no long-term effects from HSP. However, your doctor will let you know if your child needs to see a specialist kidney doctor in adulthood.
Chronic kidney disease
In a small number of children with HSP (fewer than five in 100), the kidneys stop working as well as they should – this usually happens slowly, often over many years. This is called chronic kidney disease (CKD). These children may need further care. They will need to go back to the hospital or clinic for regular follow-up appointments.
If your child has CKD, you will learn more over time about how to help manage the condition, and what to expect.
Impact on your child and family
Children who have HSP can usually do the things that other children their age do. They should be able to continue going to school or nursery. They can play with other children and, once they have recovered from the initial illness, they can be normally active.
Living healthily
Your child can help protect his or her kidneys by leading a healthy lifestyle throughout their child and adult years. This includes:
- eating a healthy diet – with at least five servings of fruit and vegetables a day, taking care not to eat too much salt, sugar and fats (especially saturated fats)
- getting plenty of exercise
- not smoking.
Further support
This can be a difficult and stressful experience for your child and the whole family, including other children.
If you have any concerns or need additional support, speak with your doctor or nurse.