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Minerva Pediatrica 2018 Nov 07

DOI: 10.23736/S0026-4946.18.05324-0

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Steroid- and immunosuppressant-based protocol of Henoch-Schönlein purpura nephritis without angiotensin inhibitors in the acute phase: case series with correlation to histology

Katsuaki KASAHARA 1, Yoshimitsu GOTOH 1, Yoshiyuki KUROYANAGI 1, China NAGANO 1, Satoshi YAMAKAWA 2, Kazuki TANAKA 2, Asami TAKEDA 3, Osamu UEMURA 4

1 Department of Pediatric Nephrology, Japanese Red Cross Nagoya Daini Hospital, Shouwaku, Nagoya-shi, Aichi-ken, Japan; 2 Department of Pediatric Nephrology, Aichi Children’s Health and Medical Center, Oobu-shi, Aichi-ken, Japan; 3 Department of Nephrology, Japanese Red Cross Nagoya Daini Hospital, Shouwaku, Nagoya-shi, Aichi-ken, Japan; 4 Ichinomiya Medical Treatment & Habilitation Center, Ichinomiya-city, Aichi, Japan


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BACKGROUND: The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines suggest initially using angiotensin-converting-enzyme inhibitors (ACE-Is) and/or angiotensin receptor blockers (ARBs) to treat Henoch-Schönlein purpura nephritis (HSPN). However, these guidelines might overlook the potential benefits of aggressive therapy. Therefore, we evaluated the efficacy of an HSPN protocol that primarily uses steroids and immunosuppressants, without ACE-Is or ARBs.
METHODS: We determine treatment intensity based on International Study of Kidney Diseases in Children (ISKDC) grading. Fifty-one patients were treated with our protocol that primarily uses steroids and immunosuppressants. ACE-Is and ARBs were not used in the acute phase, including before renal biopsy. We evaluated the proteinuria disappearance rate, duration to proteinuria disappearance, and estimated glomerular filtration rate (eGFR) at the time of last observation and compared them to those in previous reports.
RESULTS: Proteinuria disappeared in 49 patients (96%) within a median of 5 months. The median eGFR was 116.0 mL/min/1.73 m2 at the time of last observation. Six of 51 patients had acute kidney injury (eGFR <90 mL/min/1.73 m2) before treatment, but all recovered during the observation period (median 52 months).
CONCLUSIONS: Our steroid- and immunosuppressant-based protocol without ACE-Is or ARBs in the acute phase of HSPN had almost equivalent efficacy to that in previous studies that used ACE-Is and/or ARBs with steroids and immunosuppressants.


KEY WORDS: Henoch-Schönlein purpura nephritis - Steroids - Immunosuppressants - Angiotensin-converting-enzyme inhibitors - Angiotensin receptor blockers

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