Abstract
Objective
To evaluate the different therapies used to treat mild, moderate and severe Henoch-Schonlein purpura nephritis (HSPN) patients and to identify the most effective treatment.
Methods
One hundred and eighty six children were evaluated retrospectively. They were divided into mild, moderate and severe condition groups. Different therapeutic protocols of non-steroid therapy, hydrocortisone sodium succinate (HCSS) therapy, methylprednisolone (MP) pulse therapy, and MP in combination with tripterygium glycoside (TG) therapy were used to treat the different groups.
Results
After 4 wk, in the mild group, patients were more likely to respond to HCSS therapy than non-steroid therapy (P < 0.05). Moderate HSPN patients were more likely to respond to MP therapy than HCSS therapy (P < 0.05). Severe HSPN patients were more likely to respond to MP in combination with TG than single MP therapy (P < 0.05). At last follow-up, all children had normal urinalysis, blood pressure and serum urea and creatinine. In the mild group, the mean duration of proteinuria was shorter in HCSS therapy group than in non-steroid therapy group (P < 0.05). In the moderate group, the mean duration of proteinuria was shorter in MP pulse therapy group than in HCSS therapy group (P < 0.05).
Conclusions
The present study has demonstrated a superior effect of HCSS therapy in patients with mild HSPN disease, of MP therapy in patients with moderate disease, and of MP in combination with TG therapy in patients with severe disease. Intensive therapy administered initially reduces the duration of urinary protein abnormality.
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References
Gardner-Medwin JM, Dolezalova P, Cummins C, Southwood TR. Incidence of Henoch-Schönlein purpura, Kawasaki disease, and rare vasculitides in children of different ethnic origins. Lancet. 2002;360:1197–202.
Stewart M, Savage JM, Bell B, McCord B. Long term renal prognosis of Henoch-Schönlein purpura in an unselected childhood population. Eur J Pediatr. 1988;147:113–5.
Tarshish P, Bernstein J, Edelmann Jr CM. Henoch-Schönlein purpura nephritis: course of disease and efficacy of cyclophosphamide. Pediatr Nephrol. 2004;19:51–6.
Butani L, Morgenstern BZ. Long-term outcome in children after Henoch-Schonlein purpura nephritis. Clin Pediatr (Phila). 2007;46:505–11.
Edström Halling S, Söderberg MP, Berg UB. Treatment of severe Henoch-Schönlein and immunoglobulin A nephritis. A single center experience. Pediatr Nephrol. 2009;24:91–7.
Foster BJ, Bernard C, Drummond KN, Sharma AK. Effective therapy for severe Henoch-Schonlein purpura nephritis with prednisone and azathioprine: a clinical and histophatologic study. J Pediatr. 2000;136:370–5.
Flynn JT, Smoyer WE, Bunchman TE, Kershaw DB, Sedman AB. Treatment of Henoch-Schonlein Purpura glomerulonephritis in children with high-dose corticosteroids plus oral cyclophosphamide. Am J Nephrol. 2001;21:128–33.
Ronkainen J, Autio-Harmainen H, Nuutinen M. Cyclosporin A for the treatment of severe Henoch-Schonlein glomerulonephritis. Pediatr Nephrol. 2003;18:1138–42.
Iijima K, Ito-Kariya S, Nakamura H, Yoshikawa N. Multiple combined therapy for severe Henoch-Schonlein nephritis in children. Pediatr Nephrol. 1998;12:244–8.
Shenoy M, Ognjanovic MV, Coulthard MG. Treating severe Henoch-Schonlein and IgA nephritis with plasmapheresis alone. Pediatr Nephrol. 2007;22:1167–71.
Ozen S, Ruperto N, Dillon MJ, et al. EULAR/PReS endorsed consensus criteria for the classification of childhood vasculitides. Ann Rheum Dis. 2006;65:936–41.
Ronkainen J, Koskimies O, Ala-Houhala M, et al. Early prednisone therapy in Henoch-Schönlein purpura: a randomized, double-blind, placebo-controlled trial. J Pediatr. 2006;149:241–7.
Lau KK, Suzuki H, Novak J, Wyatt RJ. Pathogenesis of Henoch-Schönlein purpura nephritis. Pediatr Nephrol. 2010;25:19–26.
Niaudet P, Habib R. Methylprednisolone pulse therapy in the treatment of severe forms of Schönlein-Henoch purpura nephritis. Pediatr Nephrol. 1998;12:238–43.
Shin JI, Park JM, Shin YH, et al. Can azathioprine and steroids alter the progression of severe Henoch-Schönlein nephritis in children? Pediatr Nephrol. 2005;20:1087–92.
Shenoy M, Bradbury MG, Lewis MA, Webb NJ. Outcome of Henoch-Schönlein purpura nephritis treated with long-term immunosuppression. Pediatr Nephrol. 2007;22:1717–22.
Tanaka H, Suzuki K, Nakahata T, Ito E, Waga S. Early treatment with oral immunosuppressants in severe proteinuric purpura nephritis. Pediatr Nephrol. 2003;18:347–50.
Zheng CX, Chen ZH, Zeng CH, Qin WS, Li LS, Liu ZH. Triptolide protects podocytes from puromycin aminonucleoside induced injury in vivo and in vitro. Kidney Int. 2008;74:596–612.
Wan Y, Sun W, Zhang H, et al. Multi-glycoside of Tripterygium wilfordii Hook f. ameliorates prolonged mesangial lesions in experimental progressive glomerulonephritis. Nephron Exp Nephrol. 2010;114:e7–14.
Wan Y, Gu L, Suzuki K, et al. Multi-glycoside of Tripterygium wilfordii Hook f. ameliorates proteinuria and acute mesangial injury induced by anti-Thy1.1 monoclonal antibody. Nephron Exp Nephrol. 2005;99:e121–9.
Sharma M, Li JZ, Sharma R, et al. Inhibitory effect of Tripterygium wilfordii multiglycoside on increased glomerular albumin permeability in vitro. Nephrol Dial Transplant. 1997;12:2064–8.
Trapani S, Micheli A, Grisolia F, et al. Henoch Schonlein purpura in childhood: epidemiological and clinical analysis of 150 cases over a 5-year period and review of literature. Semin Arthritis Rheum. 2005;35:143–53.
Ronkainen J, Nuutinen M, Koskimies O. The adult kidney 24 years after childhood Henoch-Sehsnlein purpura:a retrospective cohort study. Lancet. 2002;360:666–70.
Acknowledgments
The authors thank all the staff members of the department of Nephology, First Affiliated Hospital of Anhui Medical University who kindly cooperated with this study.
Conflict of Interest
None.
Role of Funding Source
This study was financially supported by the Natural Science Foundation of Anhui province [grant number KJ2010A163] and scientific and technological project of Anhui province [grant number 11040606M168].
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Deng, F., Lu, L., Zhang, Q. et al. Improved Outcome of Henoch-Schonlein Purpura Nephritis by Early Intensive Treatment. Indian J Pediatr 79, 207–212 (2012). https://doi.org/10.1007/s12098-011-0519-5
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DOI: https://doi.org/10.1007/s12098-011-0519-5