Efficacy of methylprednisolone and urokinase pulse therapy for severe Henoch-Schönlein nephritis.
OBJECTIVE
To evaluate the efficacy of methylprednisolone and urokinase pulse therapy (MUPT) for severe Henoch-Schönlein nephritis, we examined the clinical manifestation and prognosis of patients with MUPT on long-term observation.


METHODS
We enrolled 56 patients with Henoch-schönlein nephritis who had been diagnosed with at least type IIIb from 1980 to 1998 on long-term observation and had been treated with MUPT. The clinical features, laboratory data, and pathologic findings between "pre-MUPT" and "post-MUPT," and the prognosis of these patients on long-term observation were retrospectively investigated.


RESULTS
The mean urinary protein excretion after 6 months of treatment had decreased significantly compared with "pre-MUPT." Hypercoagulant state in "after the completion of urokinase pulse therapy" improved compared with "pre-MUPT." First renal biopsies were performed in all patients and second biopsies were performed in 27 patients. The activity index decreased significantly from 4.1 +/- 1.9 at first biopsy to 2.5 +/- 1.7 at second biopsy, while the chronicity index did not differ between first and second biopsy. None had renal insufficiency and renal survival rate was 100% for the decade.


CONCLUSIONS
Although uncontrolled, our study suggested that MUPT is effective for those patients with the risk of progression of their nephropathy, especially if started early during the course of the disease before the crescents become fibrous.
Kawasaki
Yukihiko
Y
Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan. tomo@fmu.ac.jp
Suzuki
Junzo
J
Nozawa
Ruriko
R
Suzuki
Shigeo
S
Suzuki
Hitoshi
H
D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000139:chemically induced; D006130:Growth Disorders / Q000139:chemically induced; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D011695:IgA Vasculitis / Q000188:drug therapy* / Q000652:urine; D007674:Kidney Diseases / Q000188:drug therapy / Q000652:urine; D007678:Kidney Glomerulus / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage* / Q000009:adverse effects; D009393:Nephritis / Q000188:drug therapy* / Q000652:urine; D011379:Prognosis; D011507:Proteinuria / Q000188:drug therapy / Q000473:pathology; D020551:Pulse Therapy, Drug / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects
D014568:Urokinase-Type Plasminogen Activator; D008775:Methylprednisolone