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

Kawasaki, Yukihiko; Suyama, Kazuhide; Matsumoto, Ayumi; Takano, Kei; Hashimoto, Koichi; Suzuki, Syuuichirou; Suzuki, Junzo; Suzuki, Hitoshi

doi:10.1620/tjem.211.291

Cited by 16 publications

(18 citation statements)

References 12 publications

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“…This treatment decreased proteinuria, induced the disappearance of microscopic hematuria, and improved renal pathological findings. This case suggests that tonsillectomy plus methylprednisolone pulse is an effective and useful therapy for some children with recurrent purpura and persistent nephropathy 54) . Furthermore, Ohara et al reported a 13 -year -old girl with HSPN of ISKDC grade VI and persistent nephrotic syndrome despite receiving conventional therapy such as prednisolone, methylprednisolone and urokinase pulse therapy and plas-24 Y. KAWASAKI et al mapheresis (PP).…”

Section: (4) Other Types Of Treatmentmentioning

confidence: 82%

HENOCH-SCH^|^Ouml;NLEIN PURPURA NEPHRITIS IN CHILDHOOD: PATHOGENESIS, PROGNOSTIC FACTORS AND TREATMENT

Kawasaki

Ono

Ohara

et al. 2013

FJMS

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: 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. Thus, it is important to clarify the onset mechanism as well as the prognostic factors of Henoch -Schönlein purpura nephritis (HSPN) and to identify the most appropriate treatment. We herein review the pathogenesis, the prognostic factors and treatment of HSPN. As to the pathogenesis, several studies suggest that galactose -deficient IgA1 (Gd -IgA1) is recognized by anti -glycan antibodies, leading to the formation of circulating immune complexes and their mesangial deposition, thereby inducing renal injury. With regard to the prognostic factors, a number of factors have been suggested including nephrotic syndrome, decreased factor XIII activity, hypertension, severe renal injury, high renal accumulation of activated macrophage, alpha -smooth muscle actin, and high serum myeloid -related protein levels. For the treatment of severe HSPN, aggressive therapies including multiple drug combination therapy and plasmapheresis have been shown to be effective in ameliorating proteinuria and histological severity. Nevertheless, detailed investigation into the pathogenesis of HSPN and double -blind randomized control studies on children with HSPN are still necessary.

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Section: (4) Other Types Of Treatmentmentioning

confidence: 82%

HENOCH-SCH^|^Ouml;NLEIN PURPURA NEPHRITIS IN CHILDHOOD: PATHOGENESIS, PROGNOSTIC FACTORS AND TREATMENT

Kawasaki

Ono

Ohara

et al. 2013

FJMS

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“…As to the efficacy of tonsillectomy for HSPN, we reviewed 5 cases in which tonsillectomy was performed for HSPN including adults and children, and examined the epidemiology, clinical signs, treatment, and prognosis [12][13][14][15]. These published reports are listed in Table 1.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, Iwazu et al [15] reported that a monotherapeutic tonsillectomy was effective in inducing the clinical remission of HSPN. We have previously reported the effectiveness of tonsillectomy plus pulse therapy as a rescue therapy in an 11-year-old boy with HSP with recurrent purpura and persistent nephropathy [13]. However, there have been no reports on the efficacy of MUT plus PP with tonsillectomy as an initial therapy for patients with severe HSPN of ISKDC grade VI and persistent NS in childhood.…”

Section: Discussionmentioning

confidence: 99%

Successful therapy with tonsillectomy for severe ISKDC grade VI Henoch–Schönlein purpura nephritis and persistent nephrotic syndrome

et al. 2011

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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.

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“…Increased polymeric IgA production by the immune system, including the nasopharyngeal mucosa, related lymphoid structures, and glands, has been considered to be a potential mechanism of these diseases [1,7,8]. Among these tissues, the tonsils were considered to be closely related to the diseases, as well as IgA nephropathy, and several studies have focused on the potential effect of tonsillectomy as an alternative treatment for HSPN [4,5,9]. However, a tonsillectomy performed for these subjects was performed as an adjunct to immunosuppressive treatments, and it appears to be difficult to precisely evaluate the clinical benefits and the impact of tonsillectomy on the treatment of HSPN.…”

Section: Discussionmentioning

confidence: 99%

Clinical remission of Henoch–Schönlein purpura nephritis after a monotherapeutic tonsillectomy

et al. 2010

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We herein describe an adult male patient who presented with tonsillitis, purpura, hematuria, and proteinuria. The serological analyses revealed elevated serum antistreptolysin, and the throat culture yielded Lancefield group A β-hemolytic streptococci. A renal biopsy revealed mild mesangial proliferation associated with granular mesangial depositions of IgA and C3, consistent with Henoch-Schönlein purpura nephritis (HSPN). Initially, the patient was treated with dipyridamole, which was followed by limited improvements in the proteinuria and hematuria. Nine months later, the tonsillitis relapsed due to GAS infection and deteriorated urinary abnormalities were noticed, which finally disappeared after monotherapeutic tonsillectomy. Although the impact of tonsillectomy on the treatment of HSPN remains to be characterized, our observations suggest that tonsillectomy in the present patient played a pivotal role in facilitating the recovery of the renal injuries. Because the arbitrary application of a tonsillectomy appears to be accompanied by ethical concerns, the evaluation of the clinical benefits of this procedure should be addressed more directly in the future.

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

Cited by 16 publications

References 12 publications

HENOCH-SCH^|^Ouml;NLEIN PURPURA NEPHRITIS IN CHILDHOOD: PATHOGENESIS, PROGNOSTIC FACTORS AND TREATMENT

HENOCH-SCH^|^Ouml;NLEIN PURPURA NEPHRITIS IN CHILDHOOD: PATHOGENESIS, PROGNOSTIC FACTORS AND TREATMENT

Successful therapy with tonsillectomy for severe ISKDC grade VI Henoch–Schönlein purpura nephritis and persistent nephrotic syndrome

Clinical remission of Henoch–Schönlein purpura nephritis after a monotherapeutic tonsillectomy

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