Henoch Schonlein Purpura A proposed pathway for follow-up Watson L 1,2 , Richardson A 1 , Holt R.C.L 1 , Jones C.A 1 , Beresford M.W 2 . Departments of Paediatric Nephrology 1 and Rheumatology 2 , Alder Hey Children’s NHS Foundation Trust Hospital & Institute of Translational Medicine, University of Liverpool, UK
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Henoch Schonlein Purpura A proposed pathway for follow-up Watson L 1,2, Richardson A 1, Holt R.C.L 1, Jones C.A 1, Beresford M.W 2. Departments of Paediatric.
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Henoch Schonlein Purpura A proposed pathway for follow-up
Watson L1,2, Richardson A1, Holt R.C.L1, Jones C.A1, Beresford M.W2.Departments of Paediatric Nephrology1 and Rheumatology2, Alder Hey Children’s NHS Foundation
Trust Hospital & Institute of Translational Medicine, University of Liverpool, UK
Other studies• Cyclophosphamide + methylprednisolone, n=123
• Azathioprine + steroids, n=214
• Cochrane: Few RCTs5
–Sparse data, no proven benefit of treatment
• Challenges: self resolving, high risk groups, no standardised care
1. Tizard et al, unpublished, personal communication; Dudley 2007, Huber 2004, Mollica 2004, Ronkainen 2006.2. Jauhola et al, 2011 3. Flynn et al, 2001 4. Bergstein et al, 1998 5. Chartapisak W et al. 2009
– Availability of BP cuffs, paediatric phlebotomists, easy referral for paediatric advice, parental anxiety
• Stratified according to day 7 urinalysis• All urine testing undertaken by trained nurses• Revised exit criteria
The Alder Hey HSP pathway
Standard monitoring
1 month review
3 month review
6 month review Discharge
Intensive monitoringDay 14 review
1 month review
2 month review
3 month review
4 month review
6 month review
Refer for medical review
Presentation & diagnosis
Day 7 review
Exit criteria
Robust peer review
Future strategies
• Universal follow up – Clinical improvements; standardise care, equity,
improved awareness– Research opportunities; describe ‘at risk’ patients,
early intervention, facilitate RCTs
• Regional standardisation
National interest• Adoption; NW centres, Scottish region, Evelina Hospital
• UK support to adopt pathway – Welsh Paediatric Society– British Association of General Paediatrics– Scottish Paediatric Network (SPARN)– Paediatric Nephrology CSG (Prof Saleem)– Paediatric Rheumatology CSG (Prof Beresford)– General Paediatric CSG (Dr Powell)
Conclusions• All HSP patients require 6m renal screening
– Renal involvement common– Majority will have a normal renal outcome– High risk groups - proteinuria, older, non-Caucasian– Evidence based renal monitoring
• Universal monitoring with phased development
AcknowledgementsPatients, families:•Alder Hey patients and familiesAuthors:•Professor Michael Beresford•Dr. Caroline Jones•Dr. Richard Holt•Dr. Amanda RichardsonOriginal HSP pathway committee:•Dr. Gavin Cleary•Dr. Briar Stewart•Dr. Dave Casson•Elvina White•Pauline Stone
Clinicians:•Dr. Henry Morgan•Dr. Brian Judd•Dr. Eileen Baildam•Dr. Liza McCann