Eighty-five percent of cases of nephritis will present within weeks after the onset of systemic symptoms, and it is rare for nephritis to develop later than months after presentation Upon presentation to the ED, a urinalysis should be obtained to evaluate for hematuria and proteinuria If this study is normal, no further laboratory evaluation, such as evaluation of serum electrolytes or renal function, is indicated Patients will require regular follow-up with their primary care providers for serial urinalysis and monitoring of blood pressures Generally, if the urinalyses remain normal during the initial 6-month period, there is no need to screen for renal disease thereafter Children presenting with clinical evidence of nephritis such as hematuria, edema, and hypertension warrant laboratory evaluation including serum electrolytes, BUN, creatinine, and albumin in addition to urinalysis Management Most patients with HSP and associated nephritis require only supportive care, including hydration and pain control Hospitalization may be required for uncontrolled pain, significant gastrointestinal bleeding, surgical abdomen, or AKI If hypertension is present, short- or long-acting calcium channel blockers can be used ACE inhibitors may be used to reduce proteinuria Patients with HSP nephritis should undergo regular evaluation to screen for signs of progressive renal disease, such as worsening proteinuria, decreasing renal function, and hypertension Once HSP has developed, corticosteroids may be indicated for severe gastrointestinal symptoms Their efficacy in preventing nephritis has not been proven, however, and should not be started for this indication The optimal treatment of children with extensive renal disease remains controversial Prior to initiating therapy, a nephrologist should be consulted and a renal biopsy may need to be obtained to determine the extent of crescent formation, as this appears to be the best indicator of prognosis Though data are limited given the rarity of severe HSP nephritis, aggressive therapy may be beneficial in patients with severe disease These patients may benefit from treatment with steroids with or without other agents such as azathioprine, cyclophosphamide, and anticoagulants, but treatment should occur under the care of a nephrologist In children without HSP nephritis, symptoms often resolve within month One-third of patients may have recurrent symptoms, especially within the first months There is little risk of long-term impairment in