Successful Treatment of Recurrent Henoch–Schönlein Purpura in a Renal Allograft with Plasmapheresis

Lee, J.; Clayton, Frederic; Shihab, Fuad S.; Goldfarb-Rumyantzev, Alex

doi:10.1111/j.1600-6143.2007.02022.x

Cited by 25 publications

(9 citation statements)

References 16 publications

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“…In our study, no specific treatment was administered in cases with recurrent HSN. Recently, a case report showed that plasmapheresis resolved recurrent HSN after kidney transplantation (21). However, there is no randomized study on the effect of treatment on recurrent HSN.…”

Section: Discussionmentioning

confidence: 98%

Outcome of Renal Allograft in Patients With Henoch-Schönlein Nephritis: Single-Center Experience and Systematic Review

et al. 2010

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Section: Discussionmentioning

confidence: 98%

Outcome of Renal Allograft in Patients With Henoch-Schönlein Nephritis: Single-Center Experience and Systematic Review

et al. 2010

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“…Plasmapheresis might be effective by removing antibody complexes before as well as after their deposition in mesangium [10]. Unfortunately we did not have antibody titers in our patient to make a comparison.…”

Section: Discussionmentioning

confidence: 94%

241: Successful Treatment of Henoch-Schonlein Purpura Nephritis with Plasma Exchange in an Adult Male

2008

American Journal of Kidney Diseases

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Henoch-Schonlein purpura (HSP) frequently occurs in children under 15 years of age but is quite rare in adults. Most children who develop HSP nephritis completely recover from the illness, whereas up to 40% of adults have persistent hematuria and 10% develop chronic renal failure. Plasma exchange alone has been shown to be beneficial in children who have HSP nephritis. Adults have been treated using immunosuppressive drugs such as cyclophosphamide but effects are not certain. Here, we present a case of a 59-yearold white male who developed HSP nephritis while undergoing treatment with steroids. The patient developed acute renal failure with proteinuria and hematuria ∼2 weeks after being initially diagnosed with HSP by skin biopsy. Renal biopsy showed proliferative, exudative glomerulonephritis involving all 20 glomeruli; some with early crescent formation. Immunofluorescence staining showed 3+ IgA deposits in mesangium suggesting HSP-induced GN. The patient's serum creatinine rose to 2.5 mg/dl with ∼5 g of proteinuria by dipstick. Steroids were continued and the patient received plasma exchange treatments. Due to a very low leukocyte count, immunosuppressive agents were not given. Subsequently, renal function improved and the creatinine level came down to 1.3 mg/dl and proteinuria to <1 g/24 h. Since then, 1 year after this event, his serum creatinine has continued to stay at 1.2 mg/dl and he has trace proteinuria while taking a low-dose ACE inhibitor. This case illustrates the usefulness of plasma exchange in adult onset HSP nephritis, even without concomitant use of cytotoxic agents.

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“…Several case series suggest that high‐dose corticosteroid therapy, often in combination with immunosuppressive agents such as cyclophosphamide and cyclosporine A, is effective at treating severe HSPN in the native kidney. A more recent report suggests that the addition of plasmapheresis may be of benefit to severe HSPN patients, even with recurrence after transplantation . However, these treatments had no effect on her native kidney.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of recurrent Henoch–Schönlein purpura nephritis in a renal allograft with tonsillectomy and steroid pulse therapy

et al. 2016

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ABSTRACT:We report a case of recurrent Henoch-Schönlein purpura nephritis (HSPN) treated successfully with a tonsillectomy and steroid pulse therapy in a kidney transplant patient. A 29-year-old woman was admitted to our hospital for an episode biopsy; she had a serum creatinine (S-Cr) of 1.0 mg/dL and 1.34 g/day proteinuria 26 months after kidney transplantation. Histological examination revealed increased amounts of mesangial matrix and mesangial hypercellularity with IgA deposition. Of note, one glomerulus showed focal endocapillary proliferation and tuft necrosis. We diagnosed active recurrent HSPN. Considering both the histological findings and refractory clinical course of the native kidney, she was treated for 3 consecutive days with steroid pulse therapy and a tonsillectomy. The patient's proteinuria decreased gradually to less than 150 mg/day 6 months later. A second biopsy 6 years after kidney transplantation showed an excellent response to treatment and revealed a marked reduction in both the mesangial matrix and mesangial hypercellularity, with trace IgA deposition. We conclude that a tonsillectomy and steroid pulse therapy appeared to be useful in this patient with active recurrent HSPN. This paper is the first to report a tonsillectomy and steroid pulse therapy as a therapeutic option for active recurrent HSPN. Further studies are needed to elucidate the efficacy and mechanisms of tonsillectomy with recurrent HSPN in kidney transplant patients.Henoch-Schönlein purpura is a systemic small vessel vasculitis thought to be mediated by IgA immune complex deposition (IgA vasculitis). Henoch-Schönlein purpura affects the kidney in 20-80% of patients and most patients have a good prognosis. However, 3-20% of Henoch-Schönlein purpura nephritis (HSPN) has a poor outcome with a higher incidence of endstage renal disease, especially in adults. [1][2][3] Compared with IgA nephropathy, relatively little is known about recurrent HSPN in renal allografts. The recurrence rate ranges from 15% to 53%, and graft loss due to recurrent HSPN was 7.5% to 21% in different observation periods. 4 Therapy for severe HSPN usually involves methylprednisolone pulse therapy with oral corticosteroids, immunosuppressive agents, antiplatelet drugs, and plasmapheresis. Tonsillectomy has also been used in some HSPN patients, with a marked improvement in renal function and proteinuria, 3,5 but its benefit in the setting of recurrent disease in a renal allograft has not been reported. To our knowledge, this is the first report of the efficacy of tonsillectomy and steroid pulse therapy in a kidney transplant patient who developed active HSPN. CASE REPORTA 29-year-old Japanese woman was admitted to our hospital for an episode biopsy 26 months after kidney transplantation. She first presented with purpura on her lower legs, abdominal pain, macrohematuria, and proteinuria (0.5-1.0 g/ day) at 15 years of age, at which time a renal biopsy was performed and the histology revealed focal segmental

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Successful Treatment of Recurrent Henoch–Schönlein Purpura in a Renal Allograft with Plasmapheresis

Cited by 25 publications

References 16 publications

Outcome of Renal Allograft in Patients With Henoch-Schönlein Nephritis: Single-Center Experience and Systematic Review

Outcome of Renal Allograft in Patients With Henoch-Schönlein Nephritis: Single-Center Experience and Systematic Review

241: Successful Treatment of Henoch-Schonlein Purpura Nephritis with Plasma Exchange in an Adult Male

Successful treatment of recurrent Henoch–Schönlein purpura nephritis in a renal allograft with tonsillectomy and steroid pulse therapy

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