Multiple combined therapy for severe Henoch-Schonlein nephritis in children

Byline: Kazumoto Iijima (1), Seiko Ito-Kariya (1), Hajime Nakamura (1), Norishige Yoshikawa (1) Keywords: Key words: Henoch-Schonlein nephritis; Multiple combined therapy; Histological effects; Prognosis Abstract: From 1980 through 1992, 14 children with Henoch-Schonlein nephritis (HSN) showing severe glomerular changes (grade IV or V) were given a multiple combined therapy with prednisolone, cyclophosphamide, heparin/warfarin, and dipyridamole, and were followed for 7.5+-0.9 years. The period between the onset of nephritis and the start of therapy was 0.8+-0.4 years. Ten patients underwent follow-up biopsy after therapy. The percentage of glomeruli having crescents/segmental lesions was significantly reduced after therapy (70%+-5% vs. 42%+-7%, P &lt 0.01), due mainly to the resolution of crescents (51%+-8% vs. 13%+-5%, P &lt 0.01). Thus, histological grade was significantly improved (5 grade IV and 5 grade V vs. 7 grade III and 3 grade IV, P &lt 0.01). After an average follow-up period of 7.5 years, 9 patients showed normal urine and renal function, 4 showed minor urinary abnormalities, and 1 heavy proteinuria. No patient developed chronic renal insufficiency. These findings suggest that the multiple combined therapy could be effective for histologically severe HSN, although a prospective controlled study should be performed. Author Affiliation: (1) Department of Pediatrics and Faculty of Health Science, Kobe University School of Medicine, Kobe, Japan, JP Article note: Received July 2, 1997 received in revised form September 26, 1997 accepted October 2, 1997