Out of the two patients with a raised urine protein level exiting the pathway early, one developed nephrotic syndrome within the first month following diagnosis and a renal biopsy revealed grade III HSP nephritis according to the ISN classification [6]; they required immunosuppression, angiotensin converting enzyme (ACE) inhibition and a repeat biopsy seven months later demonstrated improvement with grade II HSP nephritis. Here, ACE is linked to hereditary spastic paraplegia.