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Use of renin-angiotensin system inhibitors as initial therapy in children with Henoch–Schönlein purpura nephritis of moderate severity

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A Letter to the Editors to this article was published on 07 November 2023

Abstract

Background

Cases of Henoch–Schönlein purpura nephritis (HSPN) with moderate severity were demonstrated to achieve good prognosis after treatment with renin-angiotensin system (RAS) inhibitors. However, some patients required additional treatment for recurrence after remission. This study aimed to clarify the effect of RAS inhibitors in HSPN cases with moderate severity, including the proportion of cases with recurrence and their response to additional treatment.

Methods

Among 126 patients diagnosed with HSPN between 1996 and 2019, 71 patients with clinicopathologically diagnosed HSPN of moderate severity, defined as ISKDC grade II–IIIa and serum albumin ≥ 2.5 g/dL, were investigated.

Results

Proteinuria became negative after RAS inhibitor treatment alone in all 71 cases. However, 16 (22.5%) had recurrence. Eleven recurrent cases achieved negative proteinuria again following additional treatment. At the last follow-up (median 46.5 months; IQR, 23.2–98.2), 5 patients had persistent mild proteinuria; no patients had estimated glomerular filtration rate < 90 mL/min/1.73 m2. The pathological findings in all recurrent cases were ISKDC grade IIIa. The 16 recurrent cases had significantly higher proportions of glomeruli with global/segmental sclerosis (25.0 vs. 0%, P < 0.001) and tubular atrophy/interstitial fibrosis (37.5 vs. 12.7%, P =0.0 24) than 55 cases without recurrence.

Conclusions

Japanese childhood HSPN cases with moderate severity had good outcomes without need for corticosteroids or immunosuppressants, when prescribed RAS inhibitor treatment. Even in recurrent cases, abnormal proteinuria was transient, and prognosis was excellent.

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Availability of data and material

Data from this study can be obtained from the corresponding author on reasonable request.

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Acknowledgements

We thank all of the study patients. We also extend our sincere thanks to the participating doctors for providing clinical information. Finally, we thank Alison Sherwin, PhD, from Edanz (https://jp.edanz.com/ac), for editing a draft of this manuscript.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Sadayuki Nagai, Tomoko Horinouchi, Takeshi Ninchoji, Atsushi Kondo, Yuya Aoto, Shinya Ishiko, Nana Sakakibara, China Nagano, Tomohiko Yamamura & Kandai Nozu

  2. Department of Nephrology, Hyogo Prefectural Kobe Children’s Hospital, 1-6-7 Minatojima-minamimachi, Chuo-ku, Kobe, 650-0047, Japan

    Hiroshi Kaito & Ryojiro Tanaka

  3. Department of Pediatrics, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan

    Yuko Shima

  4. Department of Pediatrics, Kakogawa Central City Hospital, 439 Honmachi, Kakogawa-cho, Kakogawa, 675-8611, Japan

    Junya Fujimura

  5. Department of Pediatrics, Japanese Red Cross Society Himeji Hospita, 1-12-1 Shimoteno, Himeji, 670-8540, Japan

    Naohiro Kamiyoshi

  6. Department of Pediatrics, Takatsuki General Hospital, 1-3-13 Kosobe-cho, Takatsuki, 569-1192, Japan

    Shingo Ishimori

  7. Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa, 903-0125, Japan

    Koichi Nakanishi

  8. Clinical Research Center, Takatsuki General Hospital, 1-3-13 Kosobe-cho, Takatsuki, 569-1192, Japan

    Norishige Yoshikawa

  9. Hyogo Prefectural Kobe Children’s Hospital, 1-6-7 Minatojima-minamimachi, Chuo-ku, Kobe, 650-0047, Japan

    Kazumoto Iijima

  10. Department of Advanced Pediatric Medicine, Kobe University Graduate School of Medicine, 1-6-7 Minatojima-minamimachi, Chuo-ku, Kobe, 650-0047, Japan

    Kazumoto Iijima

Authors
  1. Sadayuki Nagai
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  2. Tomoko Horinouchi
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  3. Takeshi Ninchoji
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  4. Atsushi Kondo
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  5. Yuya Aoto
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  6. Shinya Ishiko
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  7. Nana Sakakibara
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  8. China Nagano
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  9. Tomohiko Yamamura
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  10. Hiroshi Kaito
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  11. Ryojiro Tanaka
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  12. Yuko Shima
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  13. Junya Fujimura
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  14. Naohiro Kamiyoshi
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  15. Shingo Ishimori
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  16. Koichi Nakanishi
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  17. Norishige Yoshikawa
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  18. Kazumoto Iijima
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  19. Kandai Nozu
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Contributions

SN, TH, AK, YA, SI, NS, CN, TY, TN, HK, RT, YS, JF, NK, and SI managed the patients and conceived the study; SN, TN, and TH drafted the manuscript; KoN, NY, KI, and KaN reviewed the manuscript. All the authors have read and approved the final manuscript.

Corresponding author

Correspondence to Tomoko Horinouchi.

Ethics declarations

Ethics approval

This study involving human participants was conducted in accordance with the Declaration of Helsinki. Ethics approval was obtained from the Ethics Review Committee of Kobe University Graduate School of Medicine.

Consent to participate/Consent for publication

Informed consent for kidney biopsy was obtained and published consent requirements were not necessary because the study was retrospective.

Conflict of interest

The authors declare no competing interests.

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Nagai, S., Horinouchi, T., Ninchoji, T. et al. Use of renin-angiotensin system inhibitors as initial therapy in children with Henoch–Schönlein purpura nephritis of moderate severity. Pediatr Nephrol 37, 1845–1853 (2022). https://doi.org/10.1007/s00467-021-05395-z

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  • DOI: https://doi.org/10.1007/s00467-021-05395-z

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