Pediatrics · MU Sofia

25. Vasculitis in children.

Covers inflammation of blood vessel walls in children, starting with a table that sorts the vasculitides by vessel size. It then sets out IgA vasculitis with its diagnostic criteria, kidney follow-up and outlook, followed by Kawasaki disease with its criteria, laboratory and echo monitoring, and treatment. A closing table summarises rarer types, and a short section notes oral signs and dental bleeding risk.

Inside: 4 sections · 2 tables · 16 flashcards · 5 min

Topic 25 of 30 in the MU Sofia syllabus for Pediatrics (Medicine, Year 5). The free AceMed note covers it in 4 sections, about 522 words (5 min of reading), with 16 flashcards.

In this note

  1. Introduction
  2. IgA vasculitis (Henoch–Schönlein purpura)
  3. Kawasaki disease
  4. Rarer vasculitides

Introduction

Vasculitis is inflammation of blood vessel walls, which narrows, blocks or weakens them (aneurysms) and damages the organs they supply. In children the two big ones are IgA vasculitis (Henoch–Schönlein purpura) and Kawasaki disease; the rest are rare. They are classified by the size of vessel involved (EULAR/PRINTO/PRES).

IgA vasculitis (Henoch–Schönlein purpura)

The commonest vasculitis of childhood, mostly at 3–10 years, often 1–3 weeks after an upper respiratory infection. IgA immune complexes deposit in small vessels of skin, gut, joints and kidneys.

Diagnosis (Ankara 2008)

Palpable purpura (mandatory), mainly on the legs and buttocks, with at least one of:

  • Abdominal pain (colicky; bleeding; intussusception, often ileo-ileal).
  • Arthritis or arthralgia (knees, ankles; no lasting damage).
  • Kidney involvement: haematuria and/or proteinuria.
  • Biopsy showing IgA deposits.

Platelets and clotting are normal: the purpura is from vasculitis, not low platelets. Scrotal swelling (orchitis) can mimic torsion.

Management and outlook

  • Most settle in 4 weeks: rest, paracetamol or NSAIDs (if kidneys are normal); one third have a recurrence.
  • Steroids for severe abdominal pain or orchitis (they do not prevent kidney disease).
  • Kidney follow-up: urine dipstick and blood pressure regularly for at least 6–12 months. Nephritis (nephrotic range proteinuria, raised creatinine) needs biopsy and immunosuppression; it is the only part that can cause long-term harm (chronic kidney disease in 1–2%).

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