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Efficacy of methylprednisolone and urokinase pulse therapy for severe Henoch-Schönlein nephritis
Yukihiko Kawasaki1, Junzo Suzuki, Ruriko Nozawa
1Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan. tomo@fmu.ac.jp
Objective:
To evaluate the efficacy of methylprednisolone and urokinase pulse therapy (MUPT) for severe Henoch-Schönlein nephritis, we examined the clinical manifestation and prognosis of patients with MUPT on long-term observation.
Methods:
We enrolled 56 patients with Henoch-schönlein nephritis who had been diagnosed with at least type IIIb from 1980 to 1998 on long-term observation and had been treated with MUPT. The clinical features, laboratory data, and pathologic findings between "pre-MUPT" and "post-MUPT," and the prognosis of these patients on long-term observation were retrospectively investigated.
Results:
The mean urinary protein excretion after 6 months of treatment had decreased significantly compared with "pre-MUPT." Hypercoagulant state in "after the completion of urokinase pulse therapy" improved compared with "pre-MUPT." First renal biopsies were performed in all patients and second biopsies were performed in 27 patients. The activity index decreased significantly from 4.1 +/- 1.9 at first biopsy to 2.5 +/- 1.7 at second biopsy, while the chronicity index did not differ between first and second biopsy. None had renal insufficiency and renal survival rate was 100% for the decade.
Conclusions:
Although uncontrolled, our study suggested that MUPT is effective for those patients with the risk of progression of their nephropathy, especially if started early during the course of the disease before the crescents become fibrous.
Insights
Methylprednisolone and urokinase pulse therapy (MUPT) effectively reduced proteinuria and improved coagulation in severe Henoch-Schönlein nephritis. This treatment demonstrated a 100% renal survival rate over a decade, suggesting its efficacy in preventing nephropathy progression.
Area of Science:
- Nephrology
- Immunology
- Pediatric Nephrology
Background:
- Henoch-Schönlein nephritis (HSN) is a common childhood vasculitis.
- Severe HSN can lead to significant renal damage and long-term complications.
- Early intervention is crucial for improving outcomes in HSN.
Purpose of the Study:
- To evaluate the efficacy of methylprednisolone and urokinase pulse therapy (MUPT) for severe Henoch-Schönlein nephritis.
- To assess the clinical manifestations and long-term prognosis of patients treated with MUPT.
Main Methods:
- Retrospective analysis of 56 patients with severe HSN (type IIIb or higher) treated with MUPT.
- Comparison of clinical, laboratory, and pathological findings before and after MUPT.
- Long-term follow-up to evaluate renal survival and disease progression.
Main Results:
- Significant decrease in urinary protein excretion after 6 months of MUPT.
- Improvement in hypercoagulant state post-urokinase pulse therapy.
- Reduced renal biopsy activity index and 100% renal survival rate over a decade.
Conclusions:
- MUPT appears effective in managing severe Henoch-Schönlein nephritis.
- Early initiation of MUPT may prevent progression of nephropathy, particularly before fibrous crescent formation.
- MUPT shows promise for improving renal outcomes in at-risk HSN patients.
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