Managing Henoch-Schonlein purpura in children with fish oil and ACE inhibitor therapy.
BACKGROUND
Henoch-Schonlein purpura (HSP) is a vasculitic syndrome with palpable purpura and renal involvement. The treatment for HSP with persistent renal disease remains controversial. The kidney biopsy in HSP shows IgA deposits and fish-oil therapy has proven to be promising in halting the progression of IgA nephropathy.


METHODS
Five children with biopsy-proven HSP with repeated episodes of haematuria and proteinuria were treated with fish oil (1 g orally twice daily). In three of the five patients an angiotensin-converting enzyme inhibitor (ACEI) was added for hypertension.


RESULTS
The mean duration of follow up after starting fish-oil therapy was 49.2 weeks. The protein excretion rate prior to starting fish oil was 1041 mg/day and on the last follow-up visit the rate had decreased to 104 mg/day (P <0.05). The average blood pressure (BP) prior to therapy was 135/82. On the last follow-up visit the average BP off ACEI had decreased to 100/54 (P <0.05). After a year of follow up serum creatinine and glomerular filtration rates have remained stable at 51.2 micromol/L and 128 mL/min/1.73 m2, respectively.


CONCLUSIONS
This is the first report of abatement of HSP with fish oil and ACEI in children. There is a need for randomized prospective trials to confirm this observation.
Dixit
Mehul P
MP
Department of Pediatrics, Steele Memorial Children's Research Center, University of Arizona, Tucson, Arizona 85724, USA. mdixit@peds.arizona.edu
Dixit
Naznin M
NM
Scott
Katherine
K
D000293:Adolescent; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002648:Child; D005260:Female; D005395:Fish Oils / Q000627:therapeutic use*; D005919:Glomerular Filtration Rate; D006801:Humans; D006977:Hypertension, Renal / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D011695:IgA Vasculitis / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D007668:Kidney / Q000473:pathology; D007674:Kidney Diseases / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D011507:Proteinuria
D000806:Angiotensin-Converting Enzyme Inhibitors; D005395:Fish Oils