Ashley Rawson Profile picture
Aug 1, 2021 23 tweets 10 min read Read on X
1/
📢Hello #MedTwitter.
This month’s @ASPNeph Renal Pathology webinar is all about #IgAVasculitis #IgAVN formerly known as #HSP.

Urine for a treat!
#nephtwitter

Let’s do a quick poll! Iga Vasculitis is most common in which age group?
2/
A: <10 years, about 90% of cases of IgA Vasculitis are seen in children under 10
🤯
3/
Let's talk numbers-
1⃣Kidney involvement in 30-50%
2⃣Kidney involvement appears within 6 weeks in 91%
3⃣IgA Vasculitis preceded by URI in 50%
4⃣If nephro findings, 10% progress to ESRD/severe CKD in 10 years

PMID: 139081 PMID: 32356414 PMID: 32060820
4/
What's with the two names? PMID: 32356414

HSP 👉 Johann Schönlein 👨‍🔬 and Eduard Henoch 🧑‍🎓 made the first detailed analysis of this disease.

IgA Vasculitis 👉 Based on IgA deposited in blood vessel walls.

Check this article out on the two terms: libgallay.com/2021/01/13/iga…
5/
Tetrad of findings:
⚡️Palpable purpura
⚡️Joint pain and/or swelling
⚡️GI issues- pain, intussusception, hematochezia
⚡️Renal Involvement- hematuria, proteinuria, elevated creatinine
Uptodate
6/
How about another question?!

Can we prevent kidney disease associated with IgA vasculitis?? 😷🥼🏥
7/
A: Sadly, No…
😞
Evidence suggests that steroids early in IgA vasculitis don’t prevent kidney involvement.
PMID: 26258874
8/
We still aren't sure why IgA vasculitis happens but we have some ideas...💡
PMID: 23684700
Bacteria, viruses, and protozoa suggested as possible triggers:
9/
🧬 Some genes may predispose children:
PMID: 23684700
10/
What causes IgA Vasculitis??

Hastings et al. recently published an update on the pathogenesis of IgA vasculitis with nephritis. Check out their 4 hit hypothesis:
PMID: 33818625
11/
Diagnosis- usually clinical manifestations
🤷‍♀️ Not obvious? 🤷 Not sure? 🤷‍♂️ Don't know?
A skin biopsy can help! 🦸
PMID 9366584

Leukocytoclastic vasculitis in postcapillary venules with IgA deposition in small blood vessels of superficial dermis.
12/
What about a kidney biopsy? 🔬
Who gets one??
✅Nephrotic-range proteinuria
✅Elevated creatinine
13/
Kidney biopsy findings:
Uptodate
LM: mesangial proliferation ↔️ severe crescentic glomerulonephritis
IF: IgA deposition in the mesangium
EM: electron-dense deposits in mesangial areas, occ extends into peripheral capillary loops
14/
The ISKDC classification has long been used to evaluate severity of kidney involvement on biopsy: PMID: 28197887
🕵️📜
15/
The Oxford MEST-C classification used for IgAN is also being used more and more in IgA vasculitis:
🕵️📜
16/
What is reported on your biopsy reports?
17/
Monitoring for kidney involvement in IgA vasculitis is very important. Children should have a urine dipstick performed weekly for 6 months (97% of children with IgA Vasculitis who develop renal involvement do so within 6 months, 1st morning void preferred).
Uptodate
18/
To finish things off:

How do we treat?💊💉🏥
19/
Info on IgA vasculitis treatment is limited but here are some studies you can look into!
20/
@Landmark_neph, @nephron_andon, and @dimirenal_md also created a great timeline looking into IgA vasculitis and steroids.
21/
Refer to KDIGO 2012, European guidelines, and newer studies to get even more information on treatment.

Reply to this tweet and let us know your thoughts!
22/
Interested in learning more?? 🔎🔎

For a case-based discussion with pathologist and expert login to @ASPNeph website, July webinar. Answer questions to get #MOC2credits #Membereducation #ASPNFOAMgroup

@drM_sudha @menonshina @yardleyjojo @Trumidor
and Smitha Vidi
23/
Special thanks to @drM_sudha @priti899 @SwastiThinks
and @RoshanPGeorgeMD for all your help making my first tweetorial!

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