Prognosis of Henoch-Schonlein nephritis in children.

Abstract

S R MEADOW, FRCP, DCH, senior lecturer and consultant paediatrician a nephrotic syndrome and a high proportion of crescents in renal biopsy specimens was associated with a poor outcome. Neither the clinical presentation nor the renal morphology were, however, precise determinants of outcome. Outcome was not related to age, associated streptococcal infection, or recurrences of the rash. The clinical state two years after presentation was compared with the state six and a half years or more after presentation in 76 patients. The clinical state had changed in 32 patients, in 17 of whom it had deteriorated. It was not possible to identify with any certainty the patients who would deteriorate (or improve). Patients who have had Henoch-Schonlein nephritis should be followed up for at least five years.

Henoch–Schönlein purpura nephritis complicated by reversible posterior leukoencephalopathy syndrome

“…Although these symptoms soon improved without any treatment, renal function gradually decreased with persistent proteinuria. At age 15 she was diagnosed as having grade V of HSP nephritis at our hospital according to the established classification criteria [11], on the basis of the histological findings of biopsied renal tissue. Anticoagulants and oral prednisolone were given to the patient for two months, but the treatment was discontinued at her request.…”

Cyclosporin A therapy for Henoch–Schönlein nephritis with nephrotic-range proteinuria

“…Nephrotic syndrome was defined as hypoalbuminemia of less than 2.5 g/dl with urinary protein excretion greater than 40 mg/m 2 /h, hypercholesterolemia, and generalized edema. The glomerular changes were graded according to the classification of the International Study of Kidney Disease in Childhood (ISKDC) [9]: grade I, minimal alterations; grade II, mesangial proliferation; grade III (a), focal or (b), diffuse proliferation or sclerosis with <50% crescents; grade IV (a), focal or (b), diffuse mesangial proliferation or sclerosis with 50-75% crescents; grade V (a), focal or (b), diffuse mesangial proliferation or sclerosis with >75% crescents; grade VI, membranoproliferative-like lesion. Resolution of proteinuria was defined as trace to negative protein on urinalysis examination.…”

Henoch-Schoenlein Purpura Treated with Plasma Exchange and Azathioprine

“…1,4 Furthermore, the presence of nephritis or a nephrotic picture appears to constitute poor prognostic features. 1,5 Yoshi-kawa et al 6 recently attempted to correlate prognosis with both light microscopic and EM changes in renal biopsies of patients with HSP.…”

“…1 However, it has been shown that plasma exchange can be effective in some cases of HSP nephritis 2 as in other kinds of immune complex glomerulonephritis, such as systemic lupus erythematosus and rapidly progressive glomerulonephritis (RPGN). 3 We report a case of HSP successfully treated by plasma exchange initially, followed by immunosuppression with azathioprine.…”