title: Successful therapy with tonsillectomy for severe ISKDC grade VI Henoch-Schönlein purpura nephritis and persistent nephrotic syndrome.
abstract: Henoch-Schönlein purpura (HSP) is a systemic disorder characterized by leukocytoclastic vasculitis involving the capillaries and the deposition of IgA immune complexes. Renal involvement is the principal cause of morbidity and mortality in children with HSP. We report here a 13-year-old girl with Henoch-Schönlein purpura nephritis (HSPN) of International Study of Kidney Disease in Children (ISKDC) grade VI and persistent nephrotic syndrome despite receiving conventional therapy, such as prednisolone, methylprednisolone and urokinase pulse therapy and plasmapheresis (PP). The patient was treated with tonsillectomy, which subsequently decreased proteinuria, induced the disappearance of microscopic hematuria, and improved renal pathological findings. A regimen of methylprednisolone and urokinase pulse therapy plus PP with tonsillectomy may be an effective and useful therapy for some children with severe HSPN children of ISKDC grade VI and persistent nephrotic syndrome.
authors: Department of Pediatrics, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima, Fukushima, 960-1295, Japan.
authors: Shinichiro
authors: S
authors: Ohara
authors: Department of Pediatrics, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima, Fukushima, 960-1295, Japan. kyuki@fmu.ac.jp.
authors: Yukihiko
authors: Y
authors: Kawasaki
authors: Department of Pediatrics, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima, Fukushima, 960-1295, Japan.
authors: Hiromi
authors: H
authors: Matsuura
authors: Department of Pediatrics, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima, Fukushima, 960-1295, Japan.
authors: Tomoko
authors: T
authors: Oikawa
authors: Department of Pediatrics, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima, Fukushima, 960-1295, Japan.
authors: Kazuhide
authors: K
authors: Suyama
authors: Department of Pediatrics, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima, Fukushima, 960-1295, Japan.
authors: Mitsuaki
authors: M
authors: Hosoya
references: Nihon Jinzo Gakkai Shi. 2009;51(4):484-9
references: 19601558
references: Intern Med. 2005 Jun;44(6):611-5
references: 16020890
references: Br Med J. 1977 Jul 2;2(6078):11-4
references: 871734
references: Pediatr Nephrol. 1998 Apr;12(3):238-43
references: 9630046
references: Clin Exp Nephrol. 2011 Feb;15(1):132-5
references: 20827499
references: Clin Nephrol. 1987 May;27(5):233-7
references: 3594938
references: Pediatr Nephrol. 1998 Apr;12(3):244-8
references: 9630047
references: Clin Nephrol. 2007 May;67(5):298-305
references: 17542339
references: Pediatr Nephrol. 2004 Aug;19(8):920-3
references: 15197640
references: Pediatr Nephrol. 1989 Jul;3(3):248-53
references: 2702102
references: Pediatr Nephrol. 2006 Nov;21(11):1701-6
references: 16932894
references: J Pediatr. 1986 Jan;108(1):71-6
references: 3944697
references: Clin Nephrol. 2003 Sep;60(3):153-60
references: 14524577
references: Pediatr Nephrol. 2010 Jan;25(1):19-26
references: 19526254
references: Tohoku J Exp Med. 2007 Mar;211(3):291-5
references: 17347555
references: J Pediatr. 2000 Mar;136(3):370-5
references: 10700695
references: Am J Kidney Dis. 1999 Mar;33(3):427-33
references: 10070905