Treatment strategies for Henoch-Schِnlein purpura nephritis by histological and clinical severity
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Takeshi Ninchoji & Hiroshi Kaito & Kandai Nozu & Yuya Hashimura & Kyoko Kanda & Ichiro Kamioka & Yuko Shima & Kiyoshi Hamahira & Koichi Nakanishi &
- چاپ و سال / کشور: 2011
Description
The management of Henoch-Schonlein purpura nephritis (HSPN) is controversial. It has been revealed that some patients develop end-stage renal disease and aggressive treatment with drugs such as steroids is increasing, and some of them may be overzealous. At our institutes, our treatment decisions are based on the clinical and pathological severity of the case in an attempt to limit the indications for aggressive therapies such as steroids and immunosuppressive agents. Here, we retrospectively examined the efficacy of treatment for HSPN. Renal biopsy was performed in patients with nephrotic syndrome or persistent proteinuria for more than 3 months and patients were classified by treatment. Patients (n=31) with moderately severe HSPN (histological grade I.III and serum albumin [Alb] >2.5 g/dl) were treated with angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers. Patients (n=19) with HSPN exceeding grade III or Alb. 2.5 g/dl received combination therapy comprising prednisolone, immunosuppressants, warfarin, and dipyridamole. All patients showed resolution of proteinuria without renal dysfunction during the observation period (3.76پ} 0.37 years). Our findings support those of some earlier reports that treatment strategies for HSPN should depend on the histological and clinical severity. Furthermore, aggressive therapies, particularly combination therapies, are unnecessary for moderate.severe HSPN.
Pediatr Nephrol (2011) 26:563–569 DOI 10.1007/s00467-010-1741-5 Received: 21 July 2010 / Revised: 22 November 2010 / Accepted: 23 November 2010 / Published online: 4 January 2011
