Treatment strategies for Henoch-Schonlein purpura nephritis by histological and clinical severity
Treatment strategies for Henoch-Schonlein purpura nephritis by histological and clinical severity
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DOI：
10.1007/s00467-010-1741-5
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发表时间：
2011-04-01
影响因子：
3
通讯作者：
Matsuo, Masafumi
中科院分区：
文献类型：
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作者：
Ninchoji, Takeshi;Kaito, Hiroshi;Matsuo, Masafumi
过敏性紫癜性肾炎（HSPN）的治疗是有争议的。据透露，一些患者发展为终末期肾病，使用类固醇等药物的积极治疗正在增加，其中一些患者可能过于热心。在我们的研究所，我们的治疗决定是基于病例的临床和病理严重程度，试图限制类固醇和免疫抑制剂等积极治疗的适应症。在这里，我们回顾性研究治疗HSPN的疗效。对肾病综合征或持续性蛋白尿3个月以上的患者进行肾活检，并按治疗方法对患者进行分类。中重度HSPN患者（n = 31）（组织学分级I-III级，血清白蛋白[Alb] > 2.5 g/dl）接受血管紧张素转换酶抑制剂和/或血管紧张素受体阻滞剂治疗。HSPN超过III级或Alb a千分率2.5 g/dl的患者（n = 19）接受了包括泼尼松龙、免疫抑制剂、华法林和潘生丁的联合治疗。所有患者在观察期间（3.76 +/- 0.37年）均显示蛋白尿消退，无肾功能障碍。我们的研究结果支持了一些早期的报告，HSPN的治疗策略应取决于组织学和临床的严重程度。此外，积极的治疗，特别是联合治疗，是不必要的中重度HSPN。
The management of Henoch-Schonlein purpura nephritis (HSPN) is controversial. It has been revealed that some patients develop end-stage renal disease and aggressive treatment with drugs such as steroids is increasing, and some of them may be overzealous. At our institutes, our treatment decisions are based on the clinical and pathological severity of the case in an attempt to limit the indications for aggressive therapies such as steroids and immunosuppressive agents. Here, we retrospectively examined the efficacy of treatment for HSPN. Renal biopsy was performed in patients with nephrotic syndrome or persistent proteinuria for more than 3 months and patients were classified by treatment. Patients (n = 31) with moderately severe HSPN (histological grade I-III and serum albumin [Alb] > 2.5 g/dl) were treated with angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers. Patients (n = 19) with HSPN exceeding grade III or Alb a parts per thousand currency signaEuro parts per thousand 2.5 g/dl received combination therapy comprising prednisolone, immunosuppressants, warfarin, and dipyridamole. All patients showed resolution of proteinuria without renal dysfunction during the observation period (3.76 +/- 0.37 years). Our findings support those of some earlier reports that treatment strategies for HSPN should depend on the histological and clinical severity. Furthermore, aggressive therapies, particularly combination therapies, are unnecessary for moderate-severe HSPN.