Henoch-Schönlein purpura nephritis with nephrotic-range proteinuria: Histological regression possibly associated with cyclosporin A and steroid treatment

J. I. Shin, J. M. Park, Y. H. Shin, J. H. Kim, Jae Seung Lee, H. J. Jeong

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Objective: To clarify the therapeutic role of cyclosporin A (CyA) for patients with Henoch-Schönlein purpura nephritis (HSPN) showing nephrotic-range proteinuria. Methods: The clinical and histological findings of eight children (7.7 ± 3.8 years), who were treated with CyA and prednisolone, were evaluated retrospectively. All underwent a renal biopsy before therapy, and six of the eight patients received a follow-up biopsy after therapy. Results: The histological grade of the International Study of Kidney Disease in Children (ISKDC) was improved in all six patients who received a follow-up biopsy (pre-therapy, four grade IIIa and two grade IIIb; post-therapy, one grade I and five grade II) and it was statistically significant (p=0.031). The activity index was significantly decreased after therapy (8.3 ± 1.6 vs. 3.5 ± 1.5, p=0.031), and the chronicity index (0.5 ± 0.5 vs. 0.7 ± 1.0) and tubulointerstitial (TI) scores (1.5 ± 1.3 vs. 0.8 ± 1.6) did not change. There was a reduction in proteinuria from 3.2 ± 2.3 to 0.1 ± 0.1 g/m2/day (p=0.008) and renal function remained normal in all patients after therapy. However, one patient showed CyA-induced nephrotoxicity at a second biopsy. After an average follow-up period of 3.8 years, six patients showed normal urine and renal function, and two showed minor urinary abnormalities. Conclusion: This study suggests that CyA therapy is effective in reducing proteinuria, which is a known risk factor for the development of renal insufficiency in HSPN and may regress the renal pathology in patients with nephrotic-range proteinuria.

Original languageEnglish
Pages (from-to)392-395
Number of pages4
JournalScandinavian Journal of Rheumatology
Volume34
Issue number5
DOIs
Publication statusPublished - 2005 Jan 1

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Schoenlein-Henoch Purpura
Nephritis
Proteinuria
Cyclosporine
Steroids
Kidney
Biopsy
Therapeutics
Kidney Diseases
Prednisolone
Renal Insufficiency
Urine
Pathology

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Rheumatology
  • Immunology

Cite this

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title = "Henoch-Sch{\"o}nlein purpura nephritis with nephrotic-range proteinuria: Histological regression possibly associated with cyclosporin A and steroid treatment",
abstract = "Objective: To clarify the therapeutic role of cyclosporin A (CyA) for patients with Henoch-Sch{\"o}nlein purpura nephritis (HSPN) showing nephrotic-range proteinuria. Methods: The clinical and histological findings of eight children (7.7 ± 3.8 years), who were treated with CyA and prednisolone, were evaluated retrospectively. All underwent a renal biopsy before therapy, and six of the eight patients received a follow-up biopsy after therapy. Results: The histological grade of the International Study of Kidney Disease in Children (ISKDC) was improved in all six patients who received a follow-up biopsy (pre-therapy, four grade IIIa and two grade IIIb; post-therapy, one grade I and five grade II) and it was statistically significant (p=0.031). The activity index was significantly decreased after therapy (8.3 ± 1.6 vs. 3.5 ± 1.5, p=0.031), and the chronicity index (0.5 ± 0.5 vs. 0.7 ± 1.0) and tubulointerstitial (TI) scores (1.5 ± 1.3 vs. 0.8 ± 1.6) did not change. There was a reduction in proteinuria from 3.2 ± 2.3 to 0.1 ± 0.1 g/m2/day (p=0.008) and renal function remained normal in all patients after therapy. However, one patient showed CyA-induced nephrotoxicity at a second biopsy. After an average follow-up period of 3.8 years, six patients showed normal urine and renal function, and two showed minor urinary abnormalities. Conclusion: This study suggests that CyA therapy is effective in reducing proteinuria, which is a known risk factor for the development of renal insufficiency in HSPN and may regress the renal pathology in patients with nephrotic-range proteinuria.",
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Henoch-Schönlein purpura nephritis with nephrotic-range proteinuria : Histological regression possibly associated with cyclosporin A and steroid treatment. / Shin, J. I.; Park, J. M.; Shin, Y. H.; Kim, J. H.; Lee, Jae Seung; Jeong, H. J.

In: Scandinavian Journal of Rheumatology, Vol. 34, No. 5, 01.01.2005, p. 392-395.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Henoch-Schönlein purpura nephritis with nephrotic-range proteinuria

T2 - Histological regression possibly associated with cyclosporin A and steroid treatment

AU - Shin, J. I.

AU - Park, J. M.

AU - Shin, Y. H.

AU - Kim, J. H.

AU - Lee, Jae Seung

AU - Jeong, H. J.

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N2 - Objective: To clarify the therapeutic role of cyclosporin A (CyA) for patients with Henoch-Schönlein purpura nephritis (HSPN) showing nephrotic-range proteinuria. Methods: The clinical and histological findings of eight children (7.7 ± 3.8 years), who were treated with CyA and prednisolone, were evaluated retrospectively. All underwent a renal biopsy before therapy, and six of the eight patients received a follow-up biopsy after therapy. Results: The histological grade of the International Study of Kidney Disease in Children (ISKDC) was improved in all six patients who received a follow-up biopsy (pre-therapy, four grade IIIa and two grade IIIb; post-therapy, one grade I and five grade II) and it was statistically significant (p=0.031). The activity index was significantly decreased after therapy (8.3 ± 1.6 vs. 3.5 ± 1.5, p=0.031), and the chronicity index (0.5 ± 0.5 vs. 0.7 ± 1.0) and tubulointerstitial (TI) scores (1.5 ± 1.3 vs. 0.8 ± 1.6) did not change. There was a reduction in proteinuria from 3.2 ± 2.3 to 0.1 ± 0.1 g/m2/day (p=0.008) and renal function remained normal in all patients after therapy. However, one patient showed CyA-induced nephrotoxicity at a second biopsy. After an average follow-up period of 3.8 years, six patients showed normal urine and renal function, and two showed minor urinary abnormalities. Conclusion: This study suggests that CyA therapy is effective in reducing proteinuria, which is a known risk factor for the development of renal insufficiency in HSPN and may regress the renal pathology in patients with nephrotic-range proteinuria.

AB - Objective: To clarify the therapeutic role of cyclosporin A (CyA) for patients with Henoch-Schönlein purpura nephritis (HSPN) showing nephrotic-range proteinuria. Methods: The clinical and histological findings of eight children (7.7 ± 3.8 years), who were treated with CyA and prednisolone, were evaluated retrospectively. All underwent a renal biopsy before therapy, and six of the eight patients received a follow-up biopsy after therapy. Results: The histological grade of the International Study of Kidney Disease in Children (ISKDC) was improved in all six patients who received a follow-up biopsy (pre-therapy, four grade IIIa and two grade IIIb; post-therapy, one grade I and five grade II) and it was statistically significant (p=0.031). The activity index was significantly decreased after therapy (8.3 ± 1.6 vs. 3.5 ± 1.5, p=0.031), and the chronicity index (0.5 ± 0.5 vs. 0.7 ± 1.0) and tubulointerstitial (TI) scores (1.5 ± 1.3 vs. 0.8 ± 1.6) did not change. There was a reduction in proteinuria from 3.2 ± 2.3 to 0.1 ± 0.1 g/m2/day (p=0.008) and renal function remained normal in all patients after therapy. However, one patient showed CyA-induced nephrotoxicity at a second biopsy. After an average follow-up period of 3.8 years, six patients showed normal urine and renal function, and two showed minor urinary abnormalities. Conclusion: This study suggests that CyA therapy is effective in reducing proteinuria, which is a known risk factor for the development of renal insufficiency in HSPN and may regress the renal pathology in patients with nephrotic-range proteinuria.

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