IgA Vasculitis — SCE Dermatology MCQ

Correct answer: B — Renal disease (IgA nephropathy with risk of chronic kidney disease)

The correct answer is B, renal disease (IgA nephropathy with risk of chronic kidney disease). In adults, IgA vasculitis (Henoch-Schonlein purpura) carries a substantially higher rate and severity of nephritis than the childhood form, with greater risk of persistent proteinuria, hypertension, and progression to chronic kidney disease or end-stage renal failure. This is thought to reflect a more chronic, less self-limiting immune-complex glomerulonephritis in adults, often requiring renal biopsy, more aggressive immunosuppression, and prolonged nephrology follow-up with urinalysis and blood pressure monitoring for at least six months. Because renal impairment is the main determinant of long-term morbidity and mortality in IgA vasculitis, it is the complication that most distinguishes severe adult disease from the largely self-limiting paediatric illness. Why the other options are wrong: D. Scrotal swelling: this is a recognised feature of childhood HSP (related to testicular/scrotal vasculitis) but is not the feature that differentiates adult severity; it is not typically more common or more severe in adults. A. Joint pain: arthralgia and arthritis occur in both age groups and are actually reported more frequently in children, not adults, so this is not the discriminating feature. E. Skin purpura severity: purpuric rash is the hallmark of IgA vasculitis in both children and adults and does not show the same marked adult-versus-child difference in severity or long-term consequence as renal disease. C. Abdominal pain: gastrointestinal involvement occurs at similar or slightly increased frequency in adults but resolves without the lasting organ damage seen with nephritis, so it is not the key severity differentiator. Key point: In adult-onset IgA vasculitis, renal involvement is both more frequent and more likely to progress to chronic kidney disease than in children, making nephrology follow-up essential.

Reference: Patient.info (Patient Platform Limited), Henoch-Schonlein Purpura (professional reference), citing adult HSP series showing higher frequency of renal insufficiency and worse renal outcomes than children, https://patient.info/doctor/paediatrics/henoch-schonlein-purpura-pro