Methylprednisolone or cyclosporine a in the treatment of Henoch-Schönlein nephritis: a nationwide study.
Adolescent
Child
Cyclosporine
/ therapeutic use
Female
Finland
/ epidemiology
Follow-Up Studies
Glomerular Filtration Rate
Glomerulonephritis
/ drug therapy
Humans
IgA Vasculitis
/ complications
Immunosuppressive Agents
/ therapeutic use
Kidney Failure, Chronic
/ diagnosis
Kidney Glomerulus
/ blood supply
Male
Methylprednisolone
/ therapeutic use
Proteinuria
/ epidemiology
Retrospective Studies
Time Factors
Time-to-Treatment
Treatment Outcome
Angiotensin-converting enzyme inhibitor
Children
IgA glomerulonephritis
Immunosuppression
Nephrotic syndrome
Outcome
Vasculitis
Journal
Pediatric nephrology (Berlin, Germany)
ISSN: 1432-198X
Titre abrégé: Pediatr Nephrol
Pays: Germany
ID NLM: 8708728
Informations de publication
Date de publication:
08 2019
08 2019
Historique:
received:
20
11
2018
accepted:
14
03
2019
revised:
10
02
2019
pubmed:
8
4
2019
medline:
6
6
2020
entrez:
8
4
2019
Statut:
ppublish
Résumé
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. 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. 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/1.73m 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.
Sections du résumé
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/1.73m
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.
Identifiants
pubmed: 30955086
doi: 10.1007/s00467-019-04238-2
pii: 10.1007/s00467-019-04238-2
doi:
Substances chimiques
Immunosuppressive Agents
0
Cyclosporine
83HN0GTJ6D
Methylprednisolone
X4W7ZR7023
Types de publication
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
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