Methylprednisolone or cyclosporine a in the treatment of Henoch-Schönlein nephritis: a nationwide study. View Full Text


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Article Info

DATE

2019-04-06

AUTHORS

Mikael Koskela, Timo Jahnukainen, Kira Endén, Pekka Arikoski, Janne Kataja, Matti Nuutinen, Elisa Ylinen

ABSTRACT

BACKGROUND: Optimal treatment of Henoch-Schönlein purpura nephritis (HSN) remains unclear. We evaluated outcome of pediatric HSN patients treated initially with either methylprednisolone (MP) or cyclosporine A (CyA) in Finland between 1996 and 2011. METHODS: Outcome of 62 HSN patients was evaluated by screening urine and blood samples (n = 51) or by collecting clinical parameters from medical charts until last follow-up visit (n = 11). Sixty (97%) patients had nephrotic-range proteinuria and/or ISKDC grade ≥ III before initial treatment. Patients were initially treated with either MP pulses (n = 42) followed by oral prednisone or with CyA (n = 20). Fifty-nine (95%) patients received angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers. RESULTS: Mean follow-up time was 10.8 years (range 3.2-21.2 years). One patient developed end-stage renal disease and another had decreased renal function (eGFR < 60 mL/min/1.73m2), both initially treated with MP (3%). Six patients (5 MP, 1 CyA) had eGFR between 60 and 89 mL/min/1.73m2 (10%). Eighteen patients (13 MP, 5 CyA) had proteinuria and/or hematuria (29%) and four of them had proteinuria > 0.5 g/day at end of follow-up. Sixteen (38%) MP-treated and two (10%) CyA-treated patients needed additional immunosuppressive treatment (RR 3.81, 95% CI 1.16-14.3, p = 0.035). Late initiation of treatment was associated with an increased risk for persistent proteinuria. CONCLUSIONS: Long-term outcome was relatively good in both treatment groups. However, since urinary abnormalities may persist or develop, long-term follow-up of HSN patients is mandatory. Early initiation of treatment had a favorable effect on proteinuria. More... »

References to SciGraph publications

  • 2011-04. Treatment strategies for Henoch-Schönlein purpura nephritis by histological and clinical severity in PEDIATRIC NEPHROLOGY
  • 2006-01. Factors affecting histological regression of crescentic Henoch–Schönlein nephritis in children in PEDIATRIC NEPHROLOGY
  • 2005-08. Cyclosporin A therapy for severe Henoch-Schönlein nephritis with nephrotic syndrome in PEDIATRIC NEPHROLOGY
  • 1999-11. Clinical outcome of Schönlein-Henoch purpura nephritis in children in PEDIATRIC NEPHROLOGY
  • 2013-01. Notice in KIDNEY INTERNATIONAL SUPPLEMENTS
  • 1998-04. Methylprednisolone pulse therapy in the treatment of severe forms of Schönlein-Henoch purpura nephritis in PEDIATRIC NEPHROLOGY
  • 2018-02. Presentation of pediatric Henoch–Schönlein purpura nephritis changes with age and renal histology depends on biopsy timing in PEDIATRIC NEPHROLOGY
  • 2011-12. Cyclosporine A vs. methylprednisolone for Henoch–Schönlein nephritis: a randomized trial in PEDIATRIC NEPHROLOGY
  • 2011-03. Cyclosporin A therapy for Henoch–Schönlein nephritis with nephrotic-range proteinuria in PEDIATRIC NEPHROLOGY
  • 2012-06. Outcome of Henoch–Schönlein purpura 8 years after treatment with a placebo or prednisone at disease onset in PEDIATRIC NEPHROLOGY
  • 2003-11. Cyclosporin A for the treatment of severe Henoch-Schönlein glomerulonephritis in PEDIATRIC NEPHROLOGY
  • 2011-06. Henoch-Schönlein purpura nephritis with nephrotic state in children: predictors of poor outcomes in PEDIATRIC NEPHROLOGY
  • 1988-02. Long term renal prognosis of Henoch-Schönlein Purpura in an unselected childhood population in EUROPEAN JOURNAL OF PEDIATRICS
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    https://www.ncbi.nlm.nih.gov/pubmed/30955086


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        "description": "BACKGROUND: Optimal treatment of Henoch-Sch\u00f6nlein purpura nephritis (HSN) remains unclear. We evaluated outcome of pediatric HSN patients treated initially with either methylprednisolone (MP) or cyclosporine A (CyA) in Finland between 1996 and 2011.\nMETHODS: Outcome of 62 HSN patients was evaluated by screening urine and blood samples (n\u2009=\u200951) or by collecting clinical parameters from medical charts until last follow-up visit (n\u2009=\u200911). Sixty (97%) patients had nephrotic-range proteinuria and/or ISKDC grade\u2009\u2265\u2009III before initial treatment. Patients were initially treated with either MP pulses (n\u2009=\u200942) followed by oral prednisone or with CyA (n\u2009=\u200920). Fifty-nine (95%) patients received angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers.\nRESULTS: Mean follow-up time was 10.8\u00a0years (range 3.2-21.2\u00a0years). One patient developed end-stage renal disease and another had decreased renal function (eGFR <\u200960\u00a0mL/min/1.73m2), both initially treated with MP (3%). Six patients (5 MP, 1 CyA) had eGFR between 60 and 89\u00a0mL/min/1.73m2 (10%). Eighteen patients (13 MP, 5 CyA) had proteinuria and/or hematuria (29%) and four of them had proteinuria >\u20090.5\u00a0g/day at end of follow-up. Sixteen (38%) MP-treated and two (10%) CyA-treated patients needed additional immunosuppressive treatment (RR 3.81, 95% CI 1.16-14.3, p\u2009=\u20090.035). Late initiation of treatment was associated with an increased risk for persistent proteinuria.\nCONCLUSIONS: Long-term outcome was relatively good in both treatment groups. However, since urinary abnormalities may persist or develop, long-term follow-up of HSN patients is mandatory. Early initiation of treatment had a favorable effect on proteinuria.", 
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    38 schema:description BACKGROUND: Optimal treatment of Henoch-Schönlein purpura nephritis (HSN) remains unclear. We evaluated outcome of pediatric HSN patients treated initially with either methylprednisolone (MP) or cyclosporine A (CyA) in Finland between 1996 and 2011. METHODS: Outcome of 62 HSN patients was evaluated by screening urine and blood samples (n = 51) or by collecting clinical parameters from medical charts until last follow-up visit (n = 11). Sixty (97%) patients had nephrotic-range proteinuria and/or ISKDC grade ≥ III before initial treatment. Patients were initially treated with either MP pulses (n = 42) followed by oral prednisone or with CyA (n = 20). Fifty-nine (95%) patients received angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers. RESULTS: Mean follow-up time was 10.8 years (range 3.2-21.2 years). One patient developed end-stage renal disease and another had decreased renal function (eGFR < 60 mL/min/1.73m2), both initially treated with MP (3%). Six patients (5 MP, 1 CyA) had eGFR between 60 and 89 mL/min/1.73m2 (10%). Eighteen patients (13 MP, 5 CyA) had proteinuria and/or hematuria (29%) and four of them had proteinuria > 0.5 g/day at end of follow-up. Sixteen (38%) MP-treated and two (10%) CyA-treated patients needed additional immunosuppressive treatment (RR 3.81, 95% CI 1.16-14.3, p = 0.035). Late initiation of treatment was associated with an increased risk for persistent proteinuria. CONCLUSIONS: Long-term outcome was relatively good in both treatment groups. However, since urinary abnormalities may persist or develop, long-term follow-up of HSN patients is mandatory. Early initiation of treatment had a favorable effect on proteinuria.
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