Henoch Schonlein Purpura (HSP) is the commonest systemic vasculitis of childhood typically presenting with a palpable purpuric rash and frequently involving the renal system. We are the first group to clinically assess, critically analyse and subsequently revise a nurse led monitoring pathway for this condition.A cohort of 102 children presenting with HSP to a secondary/tertiary level UK paediatric hospital over a five year period, were monitored using a nurse led care pathway. Using this cohort, the incidence (6.21 cases per 100,000 children per year) and natural disease course of HSP nephritis (46% initial renal inflammation; 9% subsequent renal referral; 1% renal biopsy and immunosuppression) was determined. Older patients were at higher risk of requiring a renal referral (renal referral 12.3 (8.4–13.5) years vs. normal outcome 6.0 (3.7–8.5) years; p<0.01). A normal urinalysis on day 7 had a 97% (confidence interval 90 to 99%) negative predictive value in predicting a normal renal outcome.Using this data and existing literature base, The Alder Hey Henoch Schonlein Purpura Pathway was developed, a revised pathway for the screening of poor renal outcome in HSP. This is based on a six-month monitoring period for all patients presenting with HSP, which importantly prioritises patients according to the urine findings on day 7 and thus intensively monitors those at higher risk of developing nephritis. The pathway could be easily adapted for use in different settings and resources.The introduction of a standardised pathway for the monitoring of HSP will facilitate the implementation of disease registries to further our understanding of the condition and permit future clinical trials.

Aim To review the incidence of renal involvement and the natural course of Henoch Schönlein Purpura (HSP) over a 5 year period at a tertiary paediatric hospital. Method Patients were followed-up over a 1 year period, with frequency of visits dependent on proteinuria. At each visit a minimum of blood pressure and urinalysis was performed. Using a standardised data collection pathway all clinical data was collected prospectively. The primary outcome measured was the need for a consultant referral either during or after completing a year of follow-up. Results 165 patients were identifi ed presenting over 69 months, giving an incidence of 14.5 HSP cases per 100 000 children per year attending our hospital. The mean age at presentation was 7.2 years, with those requiring a renal referral signifi cantly older group.bmj.com on June 19, 2015 -Published by http://adc.bmj.com/ Downloaded from