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Outcome of Henoch-Schönlein purpura nephritis treated with long-term immunosuppression

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Abstract

This retrospective study investigated the outcome of 27 children (19 male) with Henoch-Schönlein purpura nephritis (HSN) of International Study of Kidney Disease in Children (ISKDC) grade 3b or higher treated with long-term immunosuppressive therapy in a single centre over a 10-year period. The mean age at presentation was 9.7 years. The median estimated glomerular filtration rate (eGFR) was 91.3 ml/min per 1.73 m2, with the median urine protein creatinine ratio (UP:UC) 556 mg/mmol. The treatment protocol comprised daily steroids and cyclophosphamide for 8–12 weeks followed by azathioprine and a reducing regimen of alternate-day steroids for 8–12 months. After a mean follow-up period of 7 years following presentation, 37% made a complete recovery, 40.7% had persistent proteinuria, 7.4% had persistent proteinuria and were on antihypertensive therapy and 14.8% had progressed to end-stage kidney failure (ESKF). Children with poor outcome were older at presentation (p 0.005), had more crescents (p 0.015) and had heavier proteinuria 6 months post initial biopsy (p 0.023). All of the four children with ESKF had nephrotic range proteinuria and greater than 50% crescents on initial biopsy. Despite long-term immunosuppression, the majority of children with HSN grade 3b or higher will have persistent renal abnormalities on long-term follow-up.

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Authors and Affiliations

  1. Department of Paediatric Nephrology, Royal Manchester Children’s Hospital, Manchester, M27 4HA, UK

    Mohan Shenoy, Mark G. Bradbury, Malcolm A. Lewis & Nicholas J. A. Webb

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  1. Mohan Shenoy
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  2. Mark G. Bradbury
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  3. Malcolm A. Lewis
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  4. Nicholas J. A. Webb
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Correspondence to Nicholas J. A. Webb.

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Shenoy, M., Bradbury, M.G., Lewis, M.A. et al. Outcome of Henoch-Schönlein purpura nephritis treated with long-term immunosuppression. Pediatr Nephrol 22, 1717–1722 (2007). https://doi.org/10.1007/s00467-007-0557-4

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  • DOI: https://doi.org/10.1007/s00467-007-0557-4

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