title: Outcome of Henoch-Schönlein purpura nephritis treated with long-term immunosuppression.
abstract: This retrospective study investigated the outcome of 27 children (19 male) with Henoch-Schönlein purpura nephritis (HSN) of International Study of Kidney Disease in Children (ISKDC) grade 3b or higher treated with long-term immunosuppressive therapy in a single centre over a 10-year period. The mean age at presentation was 9.7 years. The median estimated glomerular filtration rate (eGFR) was 91.3 ml/min per 1.73 m(2), with the median urine protein creatinine ratio (UP:UC) 556 mg/mmol. The treatment protocol comprised daily steroids and cyclophosphamide for 8-12 weeks followed by azathioprine and a reducing regimen of alternate-day steroids for 8-12 months. After a mean follow-up period of 7 years following presentation, 37% made a complete recovery, 40.7% had persistent proteinuria, 7.4% had persistent proteinuria and were on antihypertensive therapy and 14.8% had progressed to end-stage kidney failure (ESKF). Children with poor outcome were older at presentation (p 0.005), had more crescents (p 0.015) and had heavier proteinuria 6 months post initial biopsy (p 0.023). All of the four children with ESKF had nephrotic range proteinuria and greater than 50% crescents on initial biopsy. Despite long-term immunosuppression, the majority of children with HSN grade 3b or higher will have persistent renal abnormalities on long-term follow-up.
authors.affiliation: Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Manchester M27 4HA, UK.
authors.forename: Mohan
authors.initials: M
authors.lastname: Shenoy
authors.forename: Mark G
authors.initials: MG
authors.lastname: Bradbury
authors.forename: Malcolm A
authors.initials: MA
authors.lastname: Lewis
authors.forename: Nicholas J A
authors.initials: NJ
authors.lastname: Webb
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D017668:Age of Onset; D001379:Azathioprine / Q000627:therapeutic use*; D002648:Child; D003520:Cyclophosphamide / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D011695:IgA Vasculitis / Q000150:complications / Q000188:drug therapy*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007167:Immunotherapy; D008297:Male; D009393:Nephritis / Q000150:complications / Q000276:immunology*; D011507:Proteinuria; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D001379:Azathioprine