title: Early treatment with methylprednisolone pulse therapy combined with tonsillectomy for heavy proteinuric henoch-schönlein purpura nephritis in children.
abstract: BACKGROUND
  There is no clear consensus as to which patients with Henoch-Schönlein purpura nephritis (HSPN) at risk of a poor outcome should be treated and what therapeutic regimen should be used.
  
  
  METHODS
  Nine children with heavy proteinuric HSPN received prompt initiation of methylprednisolone pulse therapy (MPT) combined with tonsillectomy in a prospective study.
  
  
  RESULTS
  At presentation, the mean values for the patients' urine protein excretion (early-morning urinary protein/creatinine ratio), serum IgA, activity index (AI), and chronicity index (CI) were 5.0 ± 5.6 g/g Cr, 135.6 ± 56.5 mg/dl, 4.0 ± 0.7, and 1.7 ± 1.3, respectively. At the second biopsy, conducted approximately 24 months after initiation of therapy, the patients' serum albumin had significantly increased (4.4 ± 0.2, p < 0.01), and the serum IgA and AI had significantly decreased (88.1 ± 30.8 mg/dl, p < 0.05; 2.0 ± 1.2, p < 0.01, respectively), whereas the CI remained unchanged. Proteinuria disappeared within 24 months in all but 1 patient, and hematuria disappeared within 38 months in all patients. No patient showed renal impairment or experienced a recurrence and/or exacerbation of HSP/HSPN.
  
  
  CONCLUSIONS
  Early treatment with MPT combined with tonsillectomy is effective in ameliorating the histopathological progression and improving the clinical course of children with heavy proteinuric HSPN.
authors.affiliation: Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Chuo-city, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kanai
authors.forename: Emi
authors.initials: E
authors.lastname: Sawanobori
authors.forename: Anna
authors.initials: A
authors.lastname: Kobayashi
authors.forename: Kyoko
authors.initials: K
authors.lastname: Matsushita
authors.forename: Kanji
authors.initials: K
authors.lastname: Sugita
authors.forename: Kosuke
authors.initials: K
authors.lastname: Higashida