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Methylprednisolone or cyclosporine a in the treatment of Henoch-Schönlein nephritis: a nationwide study

  • Mikael KoskelaEmail author
  • Timo Jahnukainen
  • Kira Endén
  • Pekka Arikoski
  • Janne Kataja
  • Matti Nuutinen
  • Elisa Ylinen
Original Article

Abstract

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/1.73m2), both initially treated with MP (3%). Six patients (5 MP, 1 CyA) had eGFR between 60 and 89 mL/min/1.73m2 (10%). Eighteen patients (13 MP, 5 CyA) had proteinuria and/or hematuria (29%) and four of them had proteinuria > 0.5 g/day at end of follow-up. Sixteen (38%) MP-treated and two (10%) CyA-treated patients needed additional immunosuppressive treatment (RR 3.81, 95% CI 1.16–14.3, p = 0.035). Late initiation of treatment was associated with an increased risk for persistent proteinuria.

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.

Keywords

Outcome Immunosuppression Angiotensin-converting enzyme inhibitor Vasculitis IgA glomerulonephritis Nephrotic syndrome Children 

Notes

Acknowledgements

We would like to thank Mrs. Anna Vuolteenaho for language editing.

Funding

This work was supported by a grant to M.K. from the Finnish Kidney Foundation, the Päivikki and Sakari Sohlberg Foundation, the Foundation for Paediatric Research, the Paulo Foundation, and the Alma and K.A. Snellman Foundation, Oulu, Finland.

Compliance with ethical standards

Informed consent was obtained from all patients (and their guardians if necessary) who participated in the follow-up screening. The study was approved by the ethics committee of Helsinki University Hospital. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

467_2019_4238_MOESM1_ESM.pdf (201 kb)
Supplementary Table S1 (PDF 201 kb)

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Copyright information

© IPNA 2019

Authors and Affiliations

  • Mikael Koskela
    • 1
    • 2
    Email author
  • Timo Jahnukainen
    • 2
  • Kira Endén
    • 3
  • Pekka Arikoski
    • 4
  • Janne Kataja
    • 5
  • Matti Nuutinen
    • 6
    • 7
  • Elisa Ylinen
    • 2
  1. 1.Children’s Hospital, Pediatric Research Center, Helsinki University HospitalUniversity of HelsinkiHelsinkiFinland
  2. 2.Department of Pediatric Nephrology and Transplantation, New Children’s HospitalUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
  3. 3.Department of PediatricsTampere University HospitalTampereFinland
  4. 4.Department of PediatricsKuopio University Hospital and University of Eastern FinlandKuopioFinland
  5. 5.Pediatric and Adolescent MedicineTurku University HospitalTurkuFinland
  6. 6.Department of Children and AdolescentsOulu University HospitalOuluFinland
  7. 7.PEDEGO Research Unit, Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and GynecologyMedical Research Center Oulu (MRC Oulu)OuluFinland

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