Follow-up
For a well child going home, ensure the parents are aware of possible new features/complications and know whom to contact if there should be further acute problems. Warn them the disease may remit and relapse. Arrange appropriate follow-up.
The purpose of follow-up, once the acute symptoms have settled, is to detect and monitor renal involvement. This can appear up to at least 3 months after initial presentation, and may be associated with late (years later) deterioration in renal function.
BP and urinalysis must be checked weekly for the first 4 weeks and monthly until 3 months.
The first 5 of these checks could be either at the GP surgery, if the GP agrees or on the Clinical Decisions Unit (CDU).
At 3 months:
o if urine negative and BP normal, ensure GP review of BP and urinalysis at 6 months from diagnosis; with an instruction to the GP that if the 6 month check and all previous ones have been completely clear, no further follow up is required. If initial cheeks showed some abnormal urine/BP but 3 month and 6 month checks are clear, annual review by GP is indicated, for life.
o if urine positive for blood and/or protein, or BP raised: treat BP as appropriate and arrange Paediatric Consultant review at 6 months and 1 year.
At 1 year:
o if urinalysis still positive/BP raised, consider referral for renal biopsy.
o if all negative, arrange annual urinalysis and BP for life. This can normally be at GP surgery if age of child appropriate and GP happy to do this.
References:
1. Tizard EJ, Hamilton-Ayres MJ, Henoch-Schonlein Purpura. Arch Dis Child Educ Prac Ed 2008; 93:1-8
2. Chartapisak W, Opastiraku S et al. Prevention and treatment of renal disease in Henoch-Schonlein purpura: a systematic review. Arch Dis Child 2008; 94; 132-137
.
For a well child going home, ensure the parents are aware of possible new features/complications and know whom to contact if there should be further acute problems. Warn them the disease may remit and relapse. Arrange appropriate follow-up.
The purpose of follow-up, once the acute symptoms have settled, is to detect and monitor renal involvement. This can appear up to at least 3 months after initial presentation, and may be associated with late (years later) deterioration in renal function.
BP and urinalysis must be checked weekly for the first 4 weeks and monthly until 3 months.
The first 5 of these checks could be either at the GP surgery, if the GP agrees or on the Clinical Decisions Unit (CDU).
At 3 months:
o if urine negative and BP normal, ensure GP review of BP and urinalysis at 6 months from diagnosis; with an instruction to the GP that if the 6 month check and all previous ones have been completely clear, no further follow up is required. If initial cheeks showed some abnormal urine/BP but 3 month and 6 month checks are clear, annual review by GP is indicated, for life.
o if urine positive for blood and/or protein, or BP raised: treat BP as appropriate and arrange Paediatric Consultant review at 6 months and 1 year.
At 1 year:
o if urinalysis still positive/BP raised, consider referral for renal biopsy.
o if all negative, arrange annual urinalysis and BP for life. This can normally be at GP surgery if age of child appropriate and GP happy to do this.
References:
1. Tizard EJ, Hamilton-Ayres MJ, Henoch-Schonlein Purpura. Arch Dis Child Educ Prac Ed 2008; 93:1-8
2. Chartapisak W, Opastiraku S et al. Prevention and treatment of renal disease in Henoch-Schonlein purpura: a systematic review. Arch Dis Child 2008; 94; 132-137
.
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