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Abstract: SA-PO443

Long-Term Outcome of 62 Pediatric Henoch-Schönlein Nephritis Patients Treated with Methylprednisolone Pulses or Cyclosporine A

Session Information

  • Pediatric Nephrology - II
    October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1600 Pediatric Nephrology

Authors

  • Koskela, Antti, University of Helsinki and Helsinki University Hospital, Finland, Helsinki, Finland
  • Jahnukainen, Timo, Children?s Hospital, Helsinki University Hospital, Helsinki, Finland
  • Endén, Kira, Tampere University hospital, Tampere, Finland
  • Arikoski, Pekka Matti, Kuopio University Hospital, Kuopio, Finland
  • Kataja, Janne T., Turku University Hospital , Turku, Finland
  • Nuutinen, Matti, Oulu University Hospital, Oulu, Finland
  • Ylinen, Elisa, Children''s Hospital, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
Background

The optimal treatment of Henoch-Schönlein purpura nephritis (HSN) has remained unclear. We evaluated the outcome of pediatric HSN patients treated initially with methylprednisolone (MP) or cyclosporine A (CyA) in the five university hospitals in Finland between 1996 and 2011.

Methods

The medical charts were reviewed until the last follow-up visit and 47 (76 %) patients attended also additional urine and blood sample screening. MP-treated patients (n=42) received three 30 mg/kg pulses followed by oral prednisone for a median of 4.3 (IQR 3.8 – 5.9) months. Median treatment time for CyA-treated patients (n=20) was 1.2 (IQR 1.0 – 1.7) years with an initial target blood concentration of 150-200 µmol/l. Fifty-nine (95 %) patients had received ACE-Is and/or ARBs.

Results

Baseline characteristics at the time of renal biopsy and outcome after a mean follow-up of 10.8 years are shown in Table 1. Eighteen (90 %) CyA-treated and 26 (62 %) MP-treated patients achieved favorable treatment response with initial treatment and needed no additional immunosuppressive therapy (RR 1.45, 95 % CI 1.07 – 1.96, p=0.035; for favorable treatment response). One patient developed ESRD and another patient had decreased renal function (eGFR <60 ml/min/1.73m2), both initially treated with MP. Six patients (5 MP, 1 CyA) had mildly decreased renal function (eGFR 60 – 89 ml/min/1.73m2), one of them having non-nephrotic proteinuria.

Conclusion

Renal outcome was good in both treatment groups. However, CyA-treated patients needed less additional immunosuppressive treatment and none of the initially CyA-treated patients had decreased renal function (eGFR <60 ml/min/1.73m2) after 10.8 years of follow-up. Urinary abnormalities may persist or develop and therefore long-term follow-up of HSN patients is mandatory.

Table 1
Baseline characteristics at renal biopsyInitial MP treatment (n=42)Initial CyA Treatment (n=20)p-value
Age (years)9.5 ± 3.310.7 ± 3.40.16
Patients with nephrotic-range proteinuria (>40mg/m2/h)36 (86 %)14 (74 %)0.29
ISKDC grade ≥ III (%)29 (71 %)18 (90 %)0.12
Outcome at the end of follow-up   
Patients with proteinuria (%)9 (22 %)2 (11 %)0.48
Patients with hematuria (%)5 (13 %)3 (17 %)0.70
Patients with blood pressure medication (%)8 (20 %)7 (35 %)0.22
eGFR (ml/min/1.73m2)110 ± 21109 ± 120.95

Funding

  • Private Foundation Support