Mikael Koskela1,2, Timo Jahnukainen3, Kira Endén4, Pekka Arikoski5, Janne Kataja6, Matti Nuutinen7,8, Elisa Ylinen3. 1. Children's Hospital, Pediatric Research Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland. mikael.koskela@helsinki.fi. 2. Department of Pediatric Nephrology and Transplantation, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, 00290, Helsinki, Finland. mikael.koskela@helsinki.fi. 3. Department of Pediatric Nephrology and Transplantation, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, 00290, Helsinki, Finland. 4. Department of Pediatrics, Tampere University Hospital, Tampere, Finland. 5. Department of Pediatrics, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland. 6. Pediatric and Adolescent Medicine, Turku University Hospital, Turku, Finland. 7. Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland. 8. PEDEGO Research Unit, Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Medical Research Center Oulu (MRC Oulu), Oulu, Finland.
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.
BACKGROUND: Optimal treatment of Henoch-Schönlein purpura nephritis (HSN) remains unclear. We evaluated outcome of pediatric HSNpatients treated initially with either methylprednisolone (MP) or cyclosporine A (CyA) in Finland between 1996 and 2011. METHODS: Outcome of 62 HSNpatients 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 HSNpatients is mandatory. Early initiation of treatment had a favorable effect on proteinuria.
Authors: Joseph T Flynn; David C Kaelber; Carissa M Baker-Smith; Douglas Blowey; Aaron E Carroll; Stephen R Daniels; Sarah D de Ferranti; Janis M Dionne; Bonita Falkner; Susan K Flinn; Samuel S Gidding; Celeste Goodwin; Michael G Leu; Makia E Powers; Corinna Rea; Joshua Samuels; Madeline Simasek; Vidhu V Thaker; Elaine M Urbina Journal: Pediatrics Date: 2017-08-21 Impact factor: 7.124
Authors: Jaana Ronkainen; Olli Koskimies; Marja Ala-Houhala; Marjatta Antikainen; Jussi Merenmies; Jukka Rajantie; Timo Ormälä; Juha Turtinen; Matti Nuutinen Journal: J Pediatr Date: 2006-08 Impact factor: 4.406
Authors: Outi Jauhola; Jaana Ronkainen; Olli Koskimies; Marja Ala-Houhala; Pekka Arikoski; Tuula Hölttä; Timo Jahnukainen; Jukka Rajantie; Timo Ormälä; Juha Turtinen; Matti Nuutinen Journal: Arch Dis Child Date: 2010-09-18 Impact factor: 3.791