Successful treatment of recurrent Henoch-Schönlein purpura nephritis in a renal allograft with tonsillectomy and steroid pulse therapy
Takafumi YamakawaIzumi YamamotoYo KomatsuzakiTakahito NiikuraYusuke OkabayashiHaruki KatsumataMayuko KawabeAi KatsumaAki MafuneYasuyuki NakadaAkimitsu KobayashiYusuke KoikeJun MikiHiroki YamadaYudo TannoIchiro OhkidoNobuo TsuboiHiroyasu YamamotoTakashi Yokoo
10
Citation
13
Reference
10
Related Paper
Citation Trend
Abstract:
We report a case of recurrent Henoch-Schönlein purpura nephritis (HSPN) treated successfully with a tonsillectomy and steroid pulse therapy in a kidney transplant patient. A 29-year-old woman was admitted to our hospital for an episode biopsy; she had a serum creatinine (S-Cr) of 1.0 mg/dL and 1.34 g/day proteinuria 26 months after kidney transplantation. Histological examination revealed increased amounts of mesangial matrix and mesangial hypercellularity with IgA deposition. Of note, one glomerulus showed focal endocapillary proliferation and tuft necrosis. We diagnosed active recurrent HSPN. Considering both the histological findings and refractory clinical course of the native kidney, she was treated for 3 consecutive days with steroid pulse therapy and a tonsillectomy. The patient's proteinuria decreased gradually to less than 150 mg/day 6 months later. A second biopsy 6 years after kidney transplantation showed an excellent response to treatment and revealed a marked reduction in both the mesangial matrix and mesangial hypercellularity, with trace IgA deposition. We conclude that a tonsillectomy and steroid pulse therapy appeared to be useful in this patient with active recurrent HSPN. This paper is the first to report a tonsillectomy and steroid pulse therapy as a therapeutic option for active recurrent HSPN. Further studies are needed to elucidate the efficacy and mechanisms of tonsillectomy with recurrent HSPN in kidney transplant patients.Keywords:
Mizoribine
Nephritis
Cite
Citations (129)
This retrospective case series aimed at exploring the optimal urinary protein-to-creatinine ratio (uP/uCr) cut-off value to determine the need for renal biopsy in pediatric patients with isolated asymptomatic proteinuria (ASP).Data from 32 patients (16 boys, 16 girls) with persistent isolated ASP treated between January 2001 and September 2010 were analyzed. The uP/uCr cut-off value at which a renal biopsy is indicated was determined using the minimum p-value approach. An "optimal" cut-off value was selected to distinguish significant and non-significant glomerular changes.The minimum p-value approach using the χ2-test resulted in a peak uP/uCr of 0.5 g/g x Cr, which was then used to divide the patients into a low-proteinuria group and a high-proteinuria group. The proportion of significant glomerular changes was marginally higher (p = 0.097) in the high-proteinuria group than in the low-proteinuria group after adjustment for multiple tests. In addition, the number of patients with severe proteinuria at the most recent followup was higher in the high-proteinuria group than in the low-proteinuria group.The use of a uP/uCr >= 0.5 g/g x Cr may be a reasonable criterion for renal biopsy aimed at distinguishing renal outcomes in patients with persistent isolated ASP.
Cite
Citations (4)
Objective To investigate the characteristics of renal pathological grades in Henoch–Schönlein purpura nephritis (HSPN) children with mild to moderate proteinuria and the correlation between pathological grade and severity of proteinuria among this population. Methods HSPN children who were presented with mild (150 mg <24 h urinary protein <25 mg/kg) to moderate (25 mg/kg ≤24 h urinary protein <50 mg/kg) proteinuria and performed renal biopsy without steroid ± immunosuppressant treatment in the Second Xiangya Hospital between January 2010 and March 2021 were involved. We retrospectively analyzed the correlation between age, disease course, degree of proteinuria, type of immunoglobulin deposits, C3 deposits in glomeruli and renal pathological grade. Results (1) 72 HSPN children including 46 boys and 26 girls were included, with a mean age of onset of 9.01 ± 2.65 years old. The majority of these patients (62.5%) had a disease course between 1 week to 1 month. 51 patients presented with mild proteinuria and 21 patients with moderate proteinuria. (2) Renal biopsy results showed that ISKDC Grade IIIa were both predominant in mild proteinuria group (25, 49%) and moderate proteinuria group (11, 52.4%). 32 patients had grade II (44.4%), 2 had grade IIIb (2.8%), 1 had grade IV (1.4%), and 1 had grade VI (1.4%). There was no correlation between age, disease course and renal pathological grade ( p > 0.05). (3) In patients with mild proteinuria ( n = 51), 27 (52.9%) HSPN children had a pathological grade ≥ grade III. In patients with moderate proteinuria ( n = 21), 13 (61.9%) HSPN children had grade ≥ III. There was no significant difference in the proportion of renal pathological grade between the 2 groups ( p > 0.05). (4) There was no significant correlation between glomerular C3 deposits or immunoglobulin deposit types and renal pathological grade ( p = 0.776 and p = 0.056 respectively). Conclusion In HSPN children with mild to moderate proteinuria, longer disease course or heavier urinary protein level is not completely parallel with higher renal pathological grade. ISKDC grade IIIa is the most common pathological grade. Clinicians should pay great attention to the renal injury in patients with mild to moderate proteinuria.
Cite
Citations (1)
In this paper, the role of tonsillectomy and the tonsillar provocation test for infantile nephritis was described.Thirty-seven infantile nephritis patients who consulted our outpatient clinic of otolaryngology were studied.The tonsillar provocation test was performed in 29 patients, but the test was positive in only three with changes on urinary findings. These three patients received tonsillectomy, which was effective in one and ineffective in the others.In all the patients whose nephritis was aggravated after tonsillitis or fever, tonsillectomy was effective. Tonsillectomy was also effective in patients who clearly had acute tonsillitis before the onset of nephritis.In many cases, the ASO level went down after tonsillectomy, and in no case was the ASO level elevated over the normal level after tonsillectomy.In the post-infectious group, the patients whose ASO and/or ASK level were high at the onset of nephritis had a high tendency to heal.
Nephritis
Acute Tonsillitis
Cite
Citations (0)
[Objective]To explore the clinical effect of Huangkui capsule cooperated with conventional symptomatic treatment of chronic glomerular nephritis with proteinuria.[Methods]In addition to conventional therapy,Huangkui capsule has been given to 40 patients with chronic nephritis for 16 weeks.24 hours urinary protein and routine urine test were observed before treatment and 4 weeks,8 weeks,12 weeks and 16 weeks after treatment separately.[Results]After treatment,the patients' urinary protein effectively reduces.The effectiveness increases with the treatment cycle increases.The longer the treatment cycle is,the better effect is.[Conclusion]Huangkui capsule is effective in conventional symptomatic treatment of chronic glomerular nephritis with proteinuria.
Nephritis
Capsule
Cite
Citations (0)
• Drug-induced interstitial nephritis is being recognized with increasing frequency. Pharmacologic agents responsible for inducing this entity include antibiotics, diuretics, and nonsteroidal anti-inflammatory drugs. We recently examined five patients with glomerular disease and drug-induced interstitial nephritis. In three patients prior biopsy specimens documented their glomerular disease (membranous nephropathy, crescentic glomerulonephritis, and presumptive lipoid nephrosis). A second biopsy specimen showed acute interstitial nephritis and the glomerular lesion. Two additional patients had single biopsy specimens demonstrating acute interstitial nephritis and either membranous nephropathy or crescentic glomerulonephritis. Our cases emphasize the need for recognizing this complex pattern of renal disease and the difficulties encountered in rendering a proper diagnosis. (Arch Intern Med1985;145:1063-1067)
Interstitial nephritis
Nephritis
Nephrosis
Membranous Nephropathy
Cite
Citations (18)
Objective To investigate the relationship between clinical manifestation and pathology, and clarify the clinical value of renal biopsy, in order to improve the diagnosis and treatment of chronic kidney disease. Methods 308 cases with renal biopsy were analyzed retrospectively, in cluding the relationship between pathological type and clinical type, hematuria, proteinuria. Results Primary glomerulonephritis(PGN)performanced with asymptomatic urinary abnormalities(AUA), nephritic syndrome(NiS), nephrotic syndrome(NS), acute renal failure(ARF) and chronic renal failure(CRF)were 18.8%, 25.2%, 42.8%, 7.2% and 6.0%. The performance in secondary glomerulonephritis(SGN)was 3.4%, 44.8%, 25.9%, 6.9% and 19.0%. The different performance between PGN and SGN in AUA, NIS, NS and CRF was statistically significant(P 0.05), yet in ARF was insignificant(P 0.05). PGN performanced with simple hematuria, a small amount of proteinuria, moderate proteinuria and heave proteinuria were 5.6%, 27.2%, 29.2% and 38.0%. The performance in SGN was 3.4%, 20.7%, 41.4% and 34.5%. There was no significant difference(P0.05) between PGN and SGN in hematuria and proteinuria. Conclusions NS is the most common type in PGN, and NIS is most popular for SGN. The heave proteinuria is the most common type in PGN, and moderate proteinuria is the most common type in SGN.
Nephritic syndrome
Cite
Citations (0)
The finding of proteinuria in the pediatric age is a frequent phenomenon. Once detected, the immediate goal is to investigate other evidences of renal disease or its participation in systemic diseases. If proteinuria is an isolated finding, its transitoriness, persistence or relation with posture must be determined. Transitory proteinuria is a mild finding with good outlook; however, in patients with orthostatic or persistent asymptomatic proteinuria, the prognosis is uncertain; however, the measures taken must be conservative without restriction of physical activity and only in case of association to other signs, or finding of any change in renal function tests, the possibility of renal biopsy should be evaluated. The presence of proteinuria above 1 g/l. in a patient with acute nephritic syndrome, may be a sign of poor prognosis if it persists over one month and is indicative of renal biopsy. If this same degree of proteinuria is found in a nephrotic syndrome without hematuria or arterial hypertension, the necessity to practice renal biopsy is not indicated, except in the case it does not disappear following adequate treatment with corticosteroids.
Nephritic syndrome
Cite
Citations (0)
Excretory system
Cite
Citations (0)