Rifampin therapy in Henoch-Schönlein purpura nephritis accompanied by nephrotic syndrome

Treatment of Henoch-Schönlein purpura nephritis accompanied by nephrotic syndrome is still controversial, even though both corticosteroids and immunosuppressants have been used for therapy. Rifampin has been shown to induce the immunosuppressive effect in animal models due to the inhibition of protein synthesis by cells involved in the immune process. The effects of prednisone and rifampin in 7 children (group A) and prednisone and other immunosuppressants in 5 children (group B) are studied by evaluating the clinical states and morphologic changes by sequential biopsies following treatment. All cases in group A displayed no proteinuria 6.4 months (mean) after treatment, but in group B only 2 cases presented no proteinuria 20.5 months (mean) after treatment; the remaining cases had persistent proteinuria. Immunopathologically, 5 of 7 cases in group A showed decreasing intensity and extent of immune deposits, while only 1 of 5 cases in group B. This study suggests that rifampin may have a therapeutic role in the treatment of Henoch-Schönlein purpura nephritis, particularly with nephrotic syndrome. A longer period of study is needed to evaluate improvements in histopathologic findings.