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 biopsy | Initial MP treatment (n=42) | Initial CyA Treatment (n=20) | p-value |
| Age (years) | 9.5 ± 3.3 | 10.7 ± 3.4 | 0.16 |
| 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 ± 21 | 109 ± 12 | 0.95 |
Funding
- Private Foundation Support