When Purpura Involves the Kidneys: Understanding IgA Vasculitis and Kidney Health

During my years working in nephrology, I cared for patients with many different types of kidney conditions. One condition that particularly reminds me of the close connection between the immune system, blood vessels, and the kidneys is what was traditionally called Henoch-Schönlein purpura nephritis, now more commonly discussed as IgA vasculitis with kidney involvement.

It is a condition that can occur in both children and adults. What makes it important from a kidney-health perspective is that the skin findings may be obvious, while the kidney involvement can sometimes be much less noticeable.

What Is IgA Vasculitis?

IgA vasculitis is a small-vessel inflammatory condition in which IgA-containing immune complexes are involved in inflammation of small blood vessels.

It commonly affects several areas of the body, particularly:

• Skin
• Joints
• Digestive system
• Kidneys

When the kidneys are involved, it is sometimes referred to as IgA vasculitis-associated nephritis or IgA vasculitis nephritis.

Why Can the Kidneys Be Affected?

The kidneys contain millions of tiny filtering structures called glomeruli. When inflammation associated with IgA deposits affects these delicate structures, the kidney’s filtering function may be affected.

Kidney involvement can sometimes cause:

• Blood in the urine
• Protein in the urine
• Changes in kidney function
• Swelling in some individuals
• Changes in blood pressure

Importantly, kidney involvement does not always cause obvious symptoms.

This is one reason why urine testing and kidney-function monitoring are important when IgA vasculitis is suspected or diagnosed.

The Skin May Be the First Clue

One of the characteristic findings of IgA vasculitis is purpura—small reddish-purple spots, often appearing on the lower legs and feet.

These spots may not fade when pressure is applied to the skin.

However, not every purple or reddish skin lesion is caused by IgA vasculitis. There are many possible causes of purpura, so proper medical evaluation is important.

What I Learned from My Nephrology Experience

One lesson I learned during my years in nephrology is that kidney involvement can sometimes be much quieter than the symptoms occurring elsewhere in the body.

A patient may notice skin changes or joint discomfort while having little or no awareness that the kidneys are also involved.

This is why I believe that when a condition has the potential to affect the kidneys, checking the kidneys is an important part of the overall picture.

Depending on the situation, a healthcare professional may monitor:

• Urinalysis
• Urine protein
• Serum creatinine
• Estimated kidney function
• Blood pressure
• Other laboratory findings as appropriate

The exact evaluation and follow-up depend on the individual patient.

What About Acupuncture and Integrative Care?

From a Traditional Chinese Medicine perspective, health is viewed as an interaction between the body’s overall balance, circulation, nourishment, and functional systems.

Acupuncture may be considered as part of an integrative approach to overall well-being, particularly when patients are experiencing issues such as stress, sleep difficulties, fatigue, or discomfort during their recovery.

However, acupuncture should not be used as a substitute for medical evaluation or treatment of IgA vasculitis or kidney inflammation.

For patients with known or suspected kidney involvement, appropriate medical monitoring remains essential.

A Message I Would Like Patients to Remember

If you notice unexplained purple or reddish spots on your legs, particularly when accompanied by joint discomfort, abdominal symptoms, changes in urine, swelling, or other new symptoms, it is important to seek medical evaluation.

And if you have already been diagnosed with IgA vasculitis, do not assume that feeling well means the kidneys are unaffected.

Sometimes the kidneys can be involved quietly.

Listen to your body, monitor your health, and do not overlook the kidneys.