Effective therapy for severe Henoch-Schonlein purpura nephritis with prednisone and azathioprine: A clinical and histopathologic study

Efficacy of Tonsillectomy Plus Methylprednisolone Pulse Therapy for a Child with Henoch-Schoenlein Purpura Nephritis

“…We previously reported that methylprednisolone and urokinase pulse therapy with cyclophosphamide significantly reduced urinary protein excretion and prevented any increase in crescentic and sclerosed glomeruli in patients with HSPN of at least type IV (Kawasaki et al 2005). However, immunosuppressive drugs including cyclophosphamide have side effects such as oncogenesis, myelosuppression, hemorrhagic cystitis, and interstitial pneumonia (Foster et al 2000;Flynn et al 2001). These drugs do not always induce complete remission in all patients with HSPN.…”

“…For treatment of severe HSPN, some reports have described the use of multiple, combined agents, including immunosuppressive drugs (Niaudet et al 1998;Foster et al 2000;Flynn et al 2001). We previously reported that methylprednisolone and urokinase pulse therapy with cyclophosphamide significantly reduced urinary protein excretion and prevented any increase in crescentic and sclerosed glomeruli in patients with HSPN of at least type IV (Kawasaki et al 2005).…”

“…It occurs most frequently in childhood, and its prognosis is mainly determined by the severity of renal involvement . Treatment with methylprednisolone pulse therapy and oral prednisolone does not always induce complete remission in patients with Henoch-Schoenlein purpura nephritis (HSPN) (Niaudet and Habib 1998;Foster et al 2000;Flynn et al 2001;Kawasaki et al 2005). Approximately 20% of patients exhibit persistent nephropathy or progressive end-stage renal failure despite the treatment (Yoshikawa et al 1987;Habib et al 1994;Kawasaki et al 2005).…”

A Case of Henoch-Schoenlein Purpura Nephritis Recurring After 3 Years Remission

“…In addition, the rationale for using prednisolone and MZB in case of severe HSPN is that corticosteroids and immunosuppressive agents reduce IgA production and minimize the abnormal immune response and inflammatory events that follow IgA deposition in the glomeruli. Urokinase, warfarin and dipyridamole are used to inhibit the mediators of glomerular damage 4,18) . We reported here a 9 -years -old girl presenting with recurrent HSP and severe crescentic glomerulonephritis 3 years after the complete resolution of initial symptoms of HSP.…”

Pitfalls in recommending evidence-based guidelines for a protean disease like Henoch–Schönlein purpura nephritis

“…1) The relationship between the severity of initial clinical and histological signs and the long-term prognosis [1][2][3][4][5]; 2) The correlation between chronicity score and time elapsed between clinical onset of kidney involvement and renal biopsy [10]; 3) The possible rapid evolution of crescentic glomerular lesions to complete glomerulosclerosis [11]; 4) A worse evolution when treatment is delayed even shortly [12][13][14][15]; 5) CKD developing years after apparent complete resolution [1,12].…”