IgA vasculitis — branching viva

Opening question

A five-year-old boy, one week after a sore throat, presents with a raised purplish rash on his lower legs and ankles, swollen painful knees, colicky abdominal pain, and a urinalysis showing microscopic haematuria with trace protein. His platelet count and coagulation are normal. Name the diagnosis, give the EULAR/PRINTO/PRES classification criteria, and state what excludes the life-threatening mimics at the bedside. [1][4]

Branch 1 — the corticosteroid decision and the renal-prevention evidence

The diagnosis is confirmed. What is your acute management, and what is the role of the corticosteroid? State the indications, the dose, and the evidence from the Ronkainen 2006 and the Jauhola 2012 trials on whether the prednisone prevents the nephropathy. What is the renal monitoring schedule, and why is it mandatory regardless of the corticosteroid use? [2][3]

Branch 2 — the intussusception and the surgical interface

The same boy re-presents two days later with the severe worsening abdominal pain, the bile-stained vomiting, and a palpable right-sided mass. What is the complication, what is its typical location in this disease, why does it matter for the reduction method, and how is it managed? [4][6]

Branch 3 — the nephrotic presentation and the immunosuppression

The boy instead develops the oedema, the hypertension, and a nephrotic-range proteinuria six weeks into the illness. What is the significance, what is the indication for the renal biopsy, how does the International Study of Kidney Disease in Children classification guide the treatment, and what is the role of the angiotensin-converting-enzyme inhibitor and the immunosuppression? [5][6]

Closing — coordination and the long-term outcome

In one sentence, what determines the long-term outcome of IgA vasculitis, and why does the general paediatrician sit at the centre of the classification, the corticosteroid decision, the renal monitoring, and the multidisciplinary referral? [4][5]