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HSP nephritis – crescentic — RACP Paediatrics MCQ

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HardNephrologyHSP nephritis – crescenticRACP Paediatrics

The renal biopsy shows diffuse mesangial proliferation with 30% crescents (ISKDC grade IIIb). Renal function is preserved. What is the most appropriate treatment?

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Correct answer: D — Oral prednisolone

HSP nephritis with crescents on biopsy (ISKDC grade III-IV) and preserved renal function is typically treated with oral prednisolone (2 mg/kg/day tapering over 3-6 months). More aggressive immunosuppression (IV methylprednisolone ± cyclophosphamide) is reserved for rapidly progressive disease with declining renal function. Long-term monitoring of BP, proteinuria, and renal function is essential.

Reference: RCH Melbourne – 2023 – HSP Nephritis CPG; KDIGO – 2021 – IgA Vasculitis Nephritis