A retrospective study was performed of all patients at the Royal Adelaide Hospital over a ten-year period with biopsy proven Henoch-Schönlein nephritis. The records of 27 patients were examined, with emphasis on clinical and histopathological presentation, treatment and outcome. A scheme for assessing glomerular histology is presented, and severity correlated with prognosis of the disease. At presentation unfavourable prognostic indicators were acute renal impairment, crescents in greater than 20% of glomeruli, and severe glomerular histological lesions. Four patients died as a result of the disease, and 20 of the patients had evidence of continued renal abnormality at follow-up. Adult Henoch-Schönlein nephritis is a potentially catastrophic disease, and requires careful assessment at presentation.