Can azathioprine and steroids alter the progression of severe Henoch-Schönlein nephritis in children?
To evaluate the effect of azathioprine with steroids on the clinical course and histologic parameters of severe Henoch-Schönlein nephritis (HSN), 20 patients with a median age of 9.3 years (range 4.4-17 years) and a follow-up period of 4.8 years (range 1-14 years) were included in this study. The patients were divided into two groups. Ten patients received azathioprine with steroids for 8 months (group A), and the other ten received steroids alone (group B). All patients underwent renal biopsy at presentation, and ten of them who were treated with azathioprine underwent follow-up biopsy after therapy. Six patients in group A achieved clinical remission, and the remaining four showed minor urinary abnormalities at the latest observation. The histological grades of the International Study of Kidney Disease in Children (ISKDC) improved in four of the ten patients, and the activity index decreased significantly from 6.8+/-2.0 to 4.3+/-2.3 (p=0.016). In group B, however, four patients had normal urine and renal function; two had minor urinary abnormalities; one had active renal disease, and three had chronic renal insufficiency, at the latest observation. The combination treatment of azathioprine and steroids may be beneficial in ameliorating histopathological features and improving the clinical course of severe HSN.
Shin
Jae Il
JI
The Institute of Kidney Disease, Department of Pediatrics, Yonsei University College of Medicine, Seodaemun-Ku, Seoul, Korea.
Park
Jee Min
JM
Shin
Youn Ho
YH
Kim
Ji Hong
JH
Lee
Jae Seung
JS
Kim
Pyung Kil
PK
Jeong
Hyeon Joo
HJ
D000293:Adolescent; D001379:Azathioprine / Q000008:administration & dosage*; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D005921:Glomerulonephritis / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D011695:IgA Vasculitis / Q000150:complications* / Q000188:drug therapy* / Q000473:pathology; D007668:Kidney / Q000473:pathology; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D011239:Prednisolone / Q000008:administration & dosage*; D011507:Proteinuria / Q000188:drug therapy; D012189:Retrospective Studies
D011239:Prednisolone; D001379:Azathioprine; D008775:Methylprednisolone