Early treatment with oral immunosuppressants in severe proteinuric purpura nephritis.

Abstract

Nine Japanese children with severe proteinu- ric Henoch-Schonlein purpura nephritis (HSPN) re- ceived prompt initiation of oral prednisolone (1.5 mg/ kg/day) combined with an 8-week course of cyclophos- phamide (2 mg/kg/day) therapy. All underwent renal bi- opsy before and after treatment. At presentation, urine protein excretion and histologic indices of the mean ac- tivity index, the mean chronicity index and the tubuloin- terstitial (TI) scores in the patients were 5.0±1.4, 4.7±1.0, 3.9±1.6 and 3.7±0.5 g/day, respectively. Urine protein excretion, the activity index and the TI scores de- creased significantly at the second renal biopsies ob- tained at a mean interval of 23 months after the first (0.3±0.3, 2.4±0.5 and 1.4±0.7 g/day (P<0.01), respec- tively), while the chronicity index did not change. At the latest observation (mean interval 78 months), all except two showed negative proteinuria while no patient showed renal impairment. Although this case series is without controls, our experience suggests that early treatment with oral prednisolone and cyclophosphamide may be beneficial to a proportion of patients with severe proteinuric HSPN.