Clinical outcomes in children with Henoch-Schönlein purpura nephritis grade IIIa or IIIb

Pediatr Nephrol. 2011 Jul;26(7):1083-8. doi: 10.1007/s00467-011-1834-9. Epub 2011 Mar 9.

Abstract

Henoch-Schönlein purpura (HSP) is one of the most common causes of systemic vasculitis in children. The incidence of HSP nephritis (HSPN) among HSP patients has been reported to be 15-62%. Even so, what constitutes severe HSPN is controversial. In the study reported here, we retrospectively reviewed the clinical features and prognosis of 101 children with HSPN, ISKDC grade IIIa/IIIb, from January 1992 to November 2008. Patients with isolated hematuria and/or proteinuria <50 mg/kg/day received triptolide alone, and those with nephrotic range proteinuria received a combination therapy of prednisone and triptolide. Nephrotic syndrome was the most common clinical manifestation (45.5%). There were no significant differences in the clinical features (χ(2) = 2.756, P = 0.252), the side effects related to treatment (χ(2) = 2.259, P = 0.894), prognosis between IIIa and IIIb (χ(2) = 3.013, P = 0.222), or prognosis in grade IIIa patients receiving triptolide alone or triptolide and prednisone (χ(2) = 1.207, P = 0.272) and grade IIIb patients (χ(2) = 1.158, P = 0.282). No significant difference in clinical manifestations and long-term prognosis of our HSPN patients with grade IIIa or grade IIIb were found, implying that our patients with International Study and Kidney Disease in Children (ISKDC) grade IIIb were not the most severe cases of HSPN. Our results may also suggest that treatment with steroid may not alter the clinical outcome of such grade IIIa or IIIb patients.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Biopsy
  • Chi-Square Distribution
  • Child
  • Child, Preschool
  • China
  • Diterpenes / adverse effects
  • Diterpenes / therapeutic use*
  • Drug Therapy, Combination
  • Epoxy Compounds / adverse effects
  • Epoxy Compounds / therapeutic use
  • Female
  • Hematuria / drug therapy
  • Hematuria / etiology
  • Humans
  • IgA Vasculitis / complications
  • IgA Vasculitis / diagnosis
  • IgA Vasculitis / drug therapy*
  • Immunosuppressive Agents / adverse effects
  • Immunosuppressive Agents / therapeutic use*
  • Male
  • Nephritis / diagnosis
  • Nephritis / drug therapy*
  • Nephritis / etiology
  • Nephrotic Syndrome / drug therapy
  • Nephrotic Syndrome / etiology
  • Phenanthrenes / adverse effects
  • Phenanthrenes / therapeutic use*
  • Prednisone / adverse effects
  • Prednisone / therapeutic use*
  • Proteinuria / drug therapy
  • Proteinuria / etiology
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index
  • Time Factors
  • Treatment Outcome

Substances

  • Diterpenes
  • Epoxy Compounds
  • Immunosuppressive Agents
  • Phenanthrenes
  • triptolide
  • Prednisone