Browse categories and answer follow-up questions to refine your symptom profile.
Approach to the Critical Patient
Immediate priorities
Stabilization priorities
Airway compromise
Stridor
Reduced level of consciousness
Shock physiology
Hypotension
Delayed capillary refill
Hemorrhage concern
Hematemesis
Melena
Severe abdominal process
Guarding
Rebound tenderness
Renal failure concern
Oliguria
Rising creatinine trend
Rapid escalation triggers
Persistent severe abdominal pain
GI bleeding
Suspected intussusception
Nephrotic syndrome
Nephritic syndrome
Rapidly progressive glomerulonephritis pattern
CNS involvement
Pulmonary hemorrhage
Monitoring and early actions
Baseline monitoring
Blood pressure with age appropriate percentiles
Repeat measurements for confirmation
Orthostatic vitals if dehydration concern
Weight
Edema tracking
Medication dosing basis
Urine output trend
Strict intake output if admitted
Oliguria threshold individualized to age and size
Pain assessment
Joint pain severity
Abdominal pain severity
Early consult triggers
Nephrology for proteinuria or impaired kidney function
Surgery for suspected intussusception or peritonitis
Key diagnosis confirmation
Working diagnosis elements
Palpable purpura with thrombocytopenia excluded
Lower extremity predominance
Buttock involvement
One or more systemic features
Abdominal pain
Arthralgia or arthritis
Renal involvement
IgA deposition on biopsy if atypical presentation
History
Symptom pattern and timeline
Core symptom timeline
Rash onset and progression
Initial location
New lesions over days
Joint symptoms
Migratory arthralgia
Joint swelling
GI symptoms
Colicky abdominal pain
Nausea or vomiting
Renal symptoms
Dark urine
Reduced urine volume
Preceding trigger
Recent upper respiratory infection
Recent gastroenteritis
Risk features and complications
High risk historical features
GI bleeding symptoms
Hematemesis
Melena
Severe abdominal pain requiring admission
Worsening after meals
Persistent pain despite analgesia
Renal involvement indicators
Prior proteinuria history
Prior hematuria history
Scrotal pain in males
Acute onset
Associated swelling
Neurologic symptoms
Headache
Seizure
Pulmonary symptoms
Hemoptysis
Dyspnea
Medication exposures
NSAID use
Anticoagulant use
Physical Exam
Skin and musculoskeletal
Typical exam domains
Purpura characteristics
Palpable lesions
Non blanching lesions
Distribution
Lower extremities
Buttocks
Skin severity markers
Bullae
Necrosis
Joint exam
Ankles and knees
Range of motion limitation
Abdominal renal and other systems
System complication screen
Abdominal exam
Tenderness location
Guarding
Hydration status
Dry mucous membranes
Tachycardia
Blood pressure
Hypertension
Recheck after pain control
Edema
Periorbital edema
Peripheral edema
Scrotal exam if symptoms
Tenderness
Swelling
Neurologic exam if symptoms
Focal deficits
Altered mental status
Respiratory exam if symptoms
Crackles
Hypoxemia signs
Differential Diagnosis
Life threatening mimics
Immediate exclusions
Meningococcemia
Fever with rapidly progressive purpura
Toxic appearance
Sepsis with DIC
Thrombocytopenia
Coagulopathy
Hemolytic uremic syndrome
Hemolytic anemia
Acute kidney injury
Thrombotic thrombocytopenic purpura
Thrombocytopenia
Neurologic symptoms
Acute abdomen processes
Appendicitis
Volvulus
Common mimics and overlaps
Non life threatening alternatives
Immune thrombocytopenia
Isolated thrombocytopenia
Petechiae without palpable purpura
Drug eruption vasculitis
New medication exposure
Widespread rash pattern
ANCA associated vasculitis
Pulmonary renal syndrome
Positive ANCA pattern
Systemic lupus erythematosus vasculitis
Malar rash
Low complement levels
Inflammatory bowel disease with extraintestinal findings
Chronic diarrhea
Weight loss
Rocky Mountain spotted fever where endemic
Fever
Rash involving palms or soles
Acute rheumatic fever
Migratory arthritis
Carditis features
ICD-10 alignment
D69.0 Allergic purpura
N05 Glomerular disorders with hematuria
R10 Abdominal pain
Laboratory Tests
Core confirmation and safety
Baseline labs
Complete blood count for cytopenias
Platelet count for thrombocytopenia exclusion
Hemoglobin for GI bleeding assessment
Creatinine and electrolytes for renal involvement
eGFR estimate
Potassium for RAS blockade planning
Urinalysis for nephritis screening
Hematuria
Proteinuria
Urine protein creatinine ratio for proteinuria quantification
Trendable baseline
Nephrotic range threshold 200 mg/mmol
Additional labs by presentation
Targeted labs
Albumin for nephrotic syndrome
Hypoalbuminemia correlation with edema
Severity baseline for follow up
Coagulation profile for bleeding concern
PT INR
aPTT
CRP or ESR for inflammatory context
Non specific elevation
Alternative diagnosis support if very high
Stool testing for GI bleeding concern
Fecal occult blood if unclear bleeding
Stool culture if infectious trigger concern
Autoimmune and infectious workup when atypical
Expanded workup triggers
Atypical rash distribution or systemic severity
ANA
Complement levels
Pulmonary renal syndrome concern
ANCA
Anti GBM antibodies
Hepatitis risk factors
Hepatitis B testing
Hepatitis C testing
Diagnostic Tests
Scoring Systems
Classification and risk stratification
EULAR PRINTO PRES 2010 classification framework
Palpable purpura mandatory criterion
Abdominal pain as supportive criterion
Arthritis or arthralgia as supportive criterion
Renal involvement as supportive criterion
ISKDC histologic grading for IgA vasculitis nephritis
Mesangial changes and crescents classification
Higher grade association with progression risk
MEST-C Oxford score for IgA nephropathy spectrum
Mesangial hypercellularity component
Endocapillary hypercellularity component
MRI
MRI indications
CNS involvement assessment
Suspected cerebral vasculitis
Persistent focal neurologic deficits
Musculoskeletal complications
Severe focal limb pain with unclear etiology
Concern for osteomyelitis mimic
MRI limitations
Limited role in routine diagnosis
Availability and sedation needs in pediatrics
CT
CT considerations
Severe abdominal pain with unclear diagnosis
Concern for bowel ischemia
Concern for perforation
Pulmonary hemorrhage evaluation if unstable and CXR equivocal
CT chest balanced against radiation
Prefer CXR initial
CT limitations
Radiation exposure in children
Often unnecessary if ultrasound diagnostic
Ultrasound
Ultrasound first line use cases
Intussusception evaluation
Target sign
Guidance for reduction planning
Renal ultrasound when renal involvement significant
Baseline kidney size and echogenicity
Exclude obstruction if oliguria
Scrotal ultrasound for acute scrotal pain
Testicular torsion exclusion
Orchitis or epididymitis pattern
Disposition
Admission and higher level care
Admit criteria
Severe abdominal pain
Need for parenteral analgesia
Inability to tolerate oral intake
GI bleeding
Hemodynamic instability
Hemoglobin drop trend
Suspected or confirmed intussusception
Need for reduction
Surgical consultation requirement
Significant nephritis
UPCR greater than 200 mg/mmol
Hypertension
Rising creatinine
CNS involvement
Seizure
Focal deficits
Pulmonary hemorrhage
Hypoxemia
Hemoptysis
Discharge with follow up
Discharge criteria
Stable vitals
No hypotension
No new oxygen requirement
Adequate pain control with oral regimen
Joint pain controlled
Abdominal pain mild and improving
Tolerating oral intake
Hydration adequate
No persistent vomiting
No evidence of significant nephritis on initial screening
Urinalysis without proteinuria
Creatinine normal for age
Follow up plan documented
Blood pressure recheck schedule
Urinalysis monitoring schedule
Treatment
Supportive care
Symptom control foundation
Hydration strategy
Oral fluids if tolerated
IV isotonic fluids if dehydrated
Skin care
Leg elevation for edema
Compression stockings for dependent edema if tolerated
Analgesia approach
Acetaminophen dosing
Pediatrics 15 mg/kg per dose every 6 hours
Maximum 60 mg/kg per day
NSAID use criteria
Avoid in GI bleeding
Avoid in impaired kidney function
Glucocorticoids for pain and severe extrarenal disease
Steroid indications
Severe abdominal pain refractory to supportive care
Hospital based initiation when concern for complications
Monitor for masking peritonitis
Severe arthralgia limiting function
Short course consideration
Taper plan
Steroids not for nephritis prevention
No role without kidney involvement or with isolated microhematuria
Evidence statement from KDIGO practice points
Prednisone or prednisolone regimen
Oral dosing framework
Pediatrics 1 mg/kg per day
Maximum 60 mg per day
Typical duration 1 to 2 weeks then taper based on response
Adults 0.5 to 1 mg/kg per day
Typical duration individualized
Taper based on symptom control
IV methylprednisolone pulse regimen
Indications
Severe GI involvement with admission
Rapidly progressive nephritis pattern with nephrology
Dose
Pediatrics 10 to 30 mg/kg per day for 3 days
Maximum 1000 mg per day
Transition to oral steroid taper
Renal involvement management
Nephritis screening and referral
Urinalysis monitoring duration
Monthly monitoring for at least 6 months
Majority nephritis onset within 3 months
Nephrology involvement
Persistent proteinuria
Impaired kidney function
RAS blockade for proteinuria
ACE inhibitor or ARB use
Persistent proteinuria longer than 3 months
Specialist guided initiation in children
Enalapril example regimen
Pediatrics start 0.1 mg/kg per day
Titrate to effect and tolerance
Maximum 0.6 mg/kg per day
Losartan example regimen
Pediatrics start 0.7 mg/kg per day
Maximum 50 mg per day in smaller children
Higher max per adult dosing protocols when appropriate
Monitoring with RAS blockade
Creatinine trend after initiation
Potassium trend after initiation
Immunosuppression for IgA vasculitis nephritis
Steroids for nephrotic range proteinuria or RPGN
Oral prednisone or prednisolone 3 to 6 months consideration
Nephrotic range proteinuria threshold 200 mg/mmol
Histologic risk by ISKDC criteria II or higher
Pulse IV methylprednisolone consideration
Severe presentations
Transition plan to oral taper
Additional immunosuppressants when indicated
Indications
PCR greater than 200 mg/mmol with insufficient steroid response
Steroid sparing need
Specialist directed severe histology
Mycophenolate mofetil regimen
Pediatrics 600 mg/m2 twice daily
Maximum 1000 mg twice daily
CBC monitoring for cytopenias
Cyclophosphamide regimen
Pediatrics IV 500 to 750 mg/m2 monthly
Typical course 3 to 6 doses
Antiemetic and hydration protocol
Tacrolimus regimen
Pediatrics 0.05 mg/kg orally twice daily
Trough guided dosing per nephrology
Nephrotoxicity monitoring
Rituximab consideration
Refractory severe disease
Specialist directed risk benefit decision
Complication specific management
Intussusception pathway
Ultrasound confirmation
Early radiology involvement
Evaluate for pathologic lead point
Reduction planning
Pneumatic or hydrostatic reduction when stable
Surgical management when peritonitis or failed reduction
GI bleeding pathway
Hemodynamic support
IV access and fluids
Blood product support per severity
Acid suppression when upper GI bleed suspected
Proton pump inhibitor dosing per local protocol
Endoscopy consultation based on bleeding severity
Scrotal involvement pathway
Ultrasound for torsion exclusion
Time critical urology involvement if torsion concern
Orchitis supportive management when confirmed
Long term monitoring after nephritis
Follow up duration
Urinalysis and eGFR monitoring at least 5 years after episode
Lifelong individualized monitoring for treated nephritis
Special Populations
Pregnancy
Pregnancy considerations
Maternal risks
Higher risk of severe disease in adults
Kidney involvement impact on pregnancy outcomes
Medication safety
Avoid ACE inhibitors and ARBs
Glucocorticoids use when benefits outweigh risks
Obstetric coordination
Maternal fetal medicine involvement for nephritis
Blood pressure monitoring with pregnancy thresholds
Geriatric
Older adult considerations
Disease course
More severe and relapsing disease compared with children
Higher baseline comorbidity burden
Medication risks
NSAID avoidance with CKD risk
Steroid adverse effects heightened
Disposition bias
Lower threshold for admission with renal involvement
Close follow up for BP and renal function
Pediatrics
Pediatric specific approach
Typical demographics
Peak around school age
Often self limited course
Monitoring requirements
Urinalysis monthly for at least 6 months
Blood pressure checks at diagnosis and during monitoring
Admission thresholds
Severe abdominal pain
UPCR greater than 200 mg/mmol
Weight based dosing safeguards
Steroids and analgesics in mg/kg
Immunosuppressants by m2 where appropriate
Background
Epidemiology
Epidemiology overview
Most common childhood vasculitis
Typical presentation in childhood
Adult disease more severe and relapsing
Incidence estimate in children
Around 20 per 100000 children in some populations
Regional variation
Organ involvement frequency
GI involvement up to 72 percent reported in pediatric guideline background
Kidney involvement around 40 to 50 percent reported in pediatric guideline background
Pathophysiology
Mechanism summary
IgA immune complex mediated small vessel vasculitis
Leukocytoclastic vasculitis in skin
IgA deposition in vessel walls
Target organs
Skin small vessels
GI tract small vessels
Glomerular capillaries
Renal pattern overlap
IgA vasculitis nephritis shares features with IgA nephropathy
Histologic severity correlates with progression risk
Therapeutic Considerations
Treatment principles
Mild disease supportive care focus
Hydration and analgesia
Monitoring for nephritis evolution
Steroids role
Symptom control for severe pain
Nephritis treatment in nephrotic range proteinuria or RPGN
RAS blockade role
Proteinuria reduction strategy
Kidney protection framework
Immunosuppression escalation
Specialist guided for severe nephritis
Risk benefit balancing due to limited RCT data
Patient Discharge Instructions
copy discharge instructions
Home instructions bundle
Expected course
Rash and joint pain may last days to weeks
Recurrence possible
Medications
Acetaminophen as directed for pain
Avoid ibuprofen and naproxen if kidney problems or bleeding
Hydration
Regular fluids
Return if unable to keep fluids down
Monitoring plan
Urine checks and blood pressure checks for 6 months
Follow up appointments scheduled before leaving
Return immediately for
Severe belly pain
Vomiting blood
Black stools
No urine or much less urine
Swelling around eyes or legs
Severe headache
Seizure
Trouble breathing
Coughing blood
Urgent same day contact
New scrotal pain or swelling
New large bruising or widespread rash with fever
References
Clinical guidelines and society recommendations
Guideline sources
KDIGO 2025 IgA nephropathy and IgA vasculitis guideline with practice points for IgA vasculitis nephritis
Nephritis monitoring monthly for at least 6 months from presentation
No evidence for glucocorticoids to prevent nephritis without kidney involvement
UK Kidney Association initial management guideline for IgA vasculitis in children and young people
Use EULAR PRINTO PRES 2010 classification criteria recommendation
Urinalysis monitoring over 6 months recommendation
UK Kidney Association complications guideline for IgA vasculitis in children and young people
Kidney biopsy indications for severe or persistent nephritis
ACE inhibitor or ARB consideration for proteinuria under specialist guidance
Evidence based reviews and key studies
Evidence sources
SHARE European consensus recommendations publication on pediatric IgA vasculitis
Practice variation acknowledgement and consensus approach
AAFP clinical review on IgA vasculitis overview and complications
Classic triad description and self limited course framing
Open access IPNA pediatric recommendations publication for IgA nephropathy and IgA vasculitis nephritis
RAS blockade discussion context for pediatric care
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.